UnitedHealthcare to Require Prior Authorization for New AMA Genetic Testing Code
UnitedHealthcare has announced that it would start prior authorization of a recently created American Medical Association (AMA) procedure code involving genetic and molecular testing, starting April 1, 2026. The update is in line with the prior authorization requirements, which are already in existence in response to such genetic and molecular diagnostic tests.
The new requirement will be added to the list of in-scope genetic and molecular testing codes already present in the current list of in-scope genetic and molecular testing codes, with advance notification or prior authorization that UnitedHealthcare follows. As per the update, the new requirement was applied to the procedure code 0605U.
Affected Health Plans
The change impacts participating UnitedHealthcare commercial plans and Individual Exchange plans across all U.S. states, including:
- Neighborhood Health Partnership, Inc.
- UnitedHealthcare Level Funded
- UnitedHealthcare Oxford
- UnitedHealthcare of the River Valley
- UnitedHealthcare exchange plans
What Providers Need to Know
Prior authorization to code 0605U needs to be obtained by the healthcare providers prior to the date of service. The claims that are made but without prior approval that is approved shall not be granted, and providers will not be allowed to balance bill members on the services denied.
How to Submit Prior Authorization Requests
Providers are required to submit requests through the UnitedHealthcare Provider Portal using a One Healthcare ID. The submission process includes:
- Signing in to the Provider Portal
- Selecting Prior Authorizations & Notifications from the left-hand menu
- Creating a new notification or prior authorization request
- Entering the required clinical and service information and submitting the request
The providers with no One Healthcare ID are forced to undergo the registration process to access the portal.
Resources
- Genetic and molecular testing prior authorization
- Prior Authorization and Notification: Interactive User Guide
- UnitedHealthcare® commercial and Individual Exchange Medical Policies
