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New genetic and molecular prior auth program requirements
Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Jul 2, 2026
Summary
UnitedHealthcare is adding two new AMA genetic and molecular test CPT codes (0648U and 0651U) to their prior authorization requirements, effective October 1, 2026. Billing teams must ensure these codes trigger prior authorization requests before service delivery to avoid claim denials and balance billing restrictions.
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What to do
by Sep 15, 2026 · 5 steps
01Billing team must update billing system and encounter forms to require prior authorization for CPT codes 0648U and 0651U for all affected UnitedHealthcare plans.
02Verify that the system is configured to deny claims and prevent balance billing if prior authorization is not obtained before the date of service.
03Notify providers and front desk staff that these genetic and molecular tests now require pre-authorization.
04Access the UnitedHealthcare Provider Portal using One Healthcare ID to submit prior authorization requests.
05Reference the Prior Authorization and Notification Interactive Guide for training.
If missed: Failure to obtain prior authorization will result in claim denial with no balance billing option available to members.
Original notice
New genetic and molecular prior auth program requirements
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 codes announced for prior authorizationMediumEffective Apr 1, 2026 · Network NewsNew genetic and molecular codes required for prior authorizationMediumEffective Jul 1, 2026 · Prior authorizationNew genetic and molecular codes announced for prior authorizationMediumEffective Apr 1, 2026 · Prior authorization updatesBrowse every UnitedHealthcare change in the policy list