Medicaid Genetic and Molecular Code Changes: What to Review

Apr 08, 2026

2 minutes

Medicaid Genetic and Molecular Code Changes: What to Review

To align with American Medical Association code changes, UnitedHealthcare will update prior authorization and advance notification requirements for certain genetic and molecular procedure codes starting July 01, 2026.

View Codes

Affected plans

Providers are asked to review the state-specific code lists to confirm which prior authorization or advance notification requirements are being added or removed.

These changes will apply to the following UnitedHealthcare Community Plans:

Florida
Hawaii
Kansas CHIP
Kansas
Kentucky
Maryland
Michigan
Missouri
Nebraska
New Jersey
New Mexico
New York
Pennsylvania CHIP
Pennsylvania
Rhode Island
Tennessee
Texas CHIP
Texas STAR
Virginia
Washington
Wisconsin

How to submit and manage prior authorizations

To submit and manage prior authorizations, providers can use the UnitedHealthcare Provider Portal with a One Healthcare ID.

The process includes:

Sign in to the UnitedHealthcare Provider Portal
If you don’t have a One Healthcare ID, register now
Select Prior Authorizations & Notifications from the left-hand menu
Choose "Create a new notification" or "Prior authorization request."
Click "Create New Submissions."
Enter the required details and submit the request

UnitedHealthcare also directs providers to its Genetic and Molecular Testing Prior Authorization/Advance Notification Program resources for more information.

Providers who need help can use the chat feature in the UnitedHealthcare Provider Portal, which is available 24/7.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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