Medicare AdvantagePrior AuthMedium impact
Genetic Testing Services
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Pediatrics, Internal Medicine·Physician / Facility
Effective date
Mar 1, 2022
We identified it
Jun 19, 2026
Summary
Effective March 1, 2022, specific genetic testing CPT codes for Cystic Fibrosis and Spinal Muscular Atrophy no longer require prior authorization when billed with qualifying ICD-10 diagnosis codes. This applies to Medicare Advantage and commercial plans, streamlining the billing process for these genetic tests.
Action Required
Immediately: Billing team must update system settings to remove prior authorization requirements for CPT codes 81220-81224 (Cystic Fibrosis testing) and 81204, 81173, 81174, 81329, 81336, 81337 (Spinal Muscular Atrophy testing) when billed with qualifying diagnosis codes. Ensure one of the approved diagnosis codes from the full policy is included on each claim line. Review the complete policy document for the expanded list of qualifying ICD-10 diagnosis codes.