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HealthfirstMedicare Advantage · Prior Auth · Prior Authorization · Genetics, Oncology, Hematology +7 moreMedium impact

Prior Authorization for Molecular & Genomic Testing Procedure Codes and Descriptions

Effective date
Jan 1, 2021
Identified
Jun 20, 2026

Summary

Healthfirst uses eviCore to provide authorization services for genetic and molecular laboratory services requested for members enrolled in Medicare, Medicaid and Commercial plans, for dates of service beginning January 1, 2021. Prior authorization applies to the listed molecular and genomic testing procedure codes, which include BRCA1 and BRCA2 analysis, CYP drug metabolism tests, CFTR and other known familial variant analyses, cytogenomic microarray analysis, hereditary cancer and cardiac genomic panels, oncology gene expression profiles, and molecular pathology procedures Level 1 through Level 9, along with several HCPCS S-codes for specific genetic tests.

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What to do

Action · 2 steps
01Already effective January 1, 2021: Get prior authorization through eviCore for the molecular and genomic testing procedure codes listed in the policy when they are requested for Healthfirst members enrolled in Medicare, Medicaid or Commercial plans.
02Check hfproviders.org periodically for additional information about this process.

Codes mentioned

81162811638116481165811668116781173811748118581186811898119081201812028120381212812158121681217812218122281223812258122681227812288122981230812318123281238812488124981252812538125781258812598126981277812838128681289812918129281293812948129581296812978129881299813008130281303813048130681307813088131381317813188131981321813228132381325813268132781328813358133681337813468135081355813618136281363813648140081401814028140381404814058140681407814088141081411814128141381414814158141681417814228142581426814278143081431814328143381434814358143681437814388143981440814428144381445814488145081455814608146581470814718147981490814938150081503815048151881519815208152181522815258153581536815388153981540815418154281545815518155281595815968159984999G9143S3800S3840S3841S3842S3844S3845S3846S3850S3852S3854S3861S3865S3866S3870

Original notice

Prior Authorization for Molecular & Genomic Testing Procedure Codes and Descriptions
hfproviders.org · Always check the source before changing claims.
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