Medicare AdvantagePrior AuthHigh impact
Prior Authorization for Molecular & Genomic Testing Procedure Codes and Descriptions
Healthfirst·Oncology, OB-GYN, Cardiology +6 more·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Healthfirst has partnered with eviCore to manage prior authorization for all genetic and molecular testing services. This requires prior authorization for dozens of genetic testing procedure codes including BRCA testing, cystic fibrosis testing, and other hereditary condition screenings across all Healthfirst plan types.
Action Required
Immediately: Billing team must update system to require prior authorization through eviCore for all genetic and molecular testing codes listed (81162-81313 series) for Healthfirst Medicare, Medicaid, and Commercial members. Update encounter forms and provider alerts. Monitor hfproviders.org for additional process information. Claims will be denied without proper eviCore authorization.