Effective 1 de julio de 2021, the following changes are being made for several genetic testing services: 

1. Genetic testing for Cystic Fibrosis and Spinal Muscular Atrophy no longer require an authorization when filed with the appropriate diagnosis codes for procreative management. The CPT codes for these services are as follows:
   • Cystic Fibrosis – 81220, 81221, 81222, 81223, 81224, 81443
   • Spinal Muscular Atrophy – 81204, 81173, 81174, 81329, 81336, 81337

To ensure correct claims processing, one of the following diagnosis codes must be on the claim line for the test: Z31.430, Z41.438, Z31.440, Z31.441 and Z31.448. This change is applicable to Medicare Advantage plans and commercial products. Testing for services not meeting the above requirement will continue to need review using the online authorization tool to submit the request for the services being rendered.

1. Genetic testing codes 81513 and 81514 will change to not covered for Medicare Advantage plans and not medically necessary for commercial products.
2. Requests for code 81460 will be reviewed against the medical criteria found in the Genetic Testing Services policy for Medicare Advantage plans and commercial products.

For additional details related to this policy, please click here.