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1 ene, 2022

Genetic Testing Services

Effective 1 de marzo de 2022, several ICD-10 diagnosis codes will no longer require authorization when filed with the following CPT codes for genetic testing for Cystic Fibrosis and Spinal Muscular Atrophy. Incluyen:

  • Cystic Fibrosis – 81220, 81221, 81222, 81223, 81224
  • Spinal Muscular Atrophy – 81204, 81173, 81174, 81329, 81336, 81337.

Five diagnosis codes were already exempt from the authorization requirement. The list of diagnosis codes no longer requiring authorization is being expanded.

To ensure correct claims processing, one of the diagnosis codes found in the Genetic Testing policy must be on the claim line for the test.

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. Please see the full text of this policy for all applicable diagnosis codes here.

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