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New genetic and molecular codes announced for prior authorization
Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
Jun 13, 2026
Summary
Beginning April 1, 2026, UnitedHealthcare will require prior authorization for new genetic and molecular testing procedure code 0605U. This affects commercial and Individual Exchange plans, and claims will be denied without prior authorization.
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What to do
by Apr 1, 2026 · 2 steps
01Billing team must update system to require prior authorization for code 0605U before submitting claims for genetic and molecular testing.
02Use UnitedHealthcare Provider Portal to submit prior auth requests.
If missed: Failure to obtain prior authorization will result in claim denials and prohibition on balance billing members.
Original notice
New genetic and molecular codes announced for prior authorization
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →New AMA issued genetic and molecular prior auth requirementsHighEffective Jan 1, 2027 · Network NewsNew genetic and molecular prior auth program requirementsMediumEffective Oct 1, 2026 · Prior authorizationNew genetic and molecular codes required for prior authorizationMediumEffective Jul 1, 2026 · Prior authorizationMedicaid: View new genetic and molecular code updatesMediumEffective Jul 1, 2026 · State newsBrowse every UnitedHealthcare change in the policy list