UnitedHealthcare Announces Changes to Genetic and Molecular Testing Coverage

UnitedHealthcare has recently informed about the changes it will make to genetic and molecular testing coverages, as well as prior authorization policies starting January 1, 2025. Such changes will affect some UnitedHealthcare commercial plans and all UnitedHealthcare Exchange plans.

In the upgrade, UnitedHealthcare will allow coverage on some codes and eliminate prior authorization on some multi-panel pharmacogenetic testing procedures.

Affected UnitedHealthcare Plans Include:

• UnitedHealthcare of the Mid-Atlantic, Inc.
• UnitedHealthcare Plan of the River Valley, Inc.
• UnitedHealthcare Insurance Company of the River Valley
• Oxford Health Insurance, Inc.
• Harvard Pilgrim Health Care
• All Savers Insurance Company
• All Savers Life Insurance Company of California
• UnitedHealthcare Exchange plans
• Neighborhood Health Partnership, Inc.

Procedure Codes No Longer Requiring Prior Authorization:

• 0029U
• 0173U
• 0175U
• 0345U
• 0411U
• 0419U
• 0423U
• 0460U
• 0476U
• 0477U
• 81418

For more information or to register for training, providers can visit the Genetic and Molecular Testing Prior Authorization/Advance Notification Program website.