Prior authorization codes
Commonwealth Care Alliance
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 1000C | metabolism), gene analysis, common variant(s) (eg, - >A, c.173+ >T) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 1298C | hypercoagulability) gene analysis, common variants (eg, 677T, ) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 1639G | metabolism), gene analysis, common variant(s) (eg, - >A, c.173+ >T) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81105 | Human Platelet Antigen 1 genotyping (HPA-1), ITGB3 (integrin, beta 3 [platelet | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81106 | Human Platelet Antigen 2 genotyping (HPA-2), GP1BA (glycoprotein Ib [platelet] | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81107 | Human Platelet Antigen 3 genotyping (HPA-3), ITGA2B (integrin, alpha 2b [platelet | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81108 | Human Platelet Antigen 4 genotyping (HPA-4), ITGB3 (integrin, beta 3 [platelet | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81109 | Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81110 | Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3 (integrin, beta 3 [platelet | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81111 | Human Platelet Antigen 9 genotyping (HPA-9w), ITGA2B (integrin, alpha 2b [platelet | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81112 | Human Platelet Antigen 15 genotyping (HPA-15), CD109 (CD109 molecule) (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81120 | IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg, glioma), common variants | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81121 | IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (eg, glioma), common | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81161 | DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81162 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81163 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81164 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81165 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81166 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81167 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81168 | CCND1/IGH (t(11;14)) (eg, mantle cell lymphoma) translocation analysis, major | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81170 | ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81171 | AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg, fragile X intellectual | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81172 | AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg, fragile X intellectual | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81173 | AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81174 | AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81175 | ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81176 | ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81177 | ATN1 (atrophin 1) (eg, dentatorubral-pallidoluysian atrophy) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81178 | ATXN1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81179 | ATXN2 (ataxin 2) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81180 | ATXN3 (ataxin 3) (eg, spinocerebellar ataxia, Machado-Joseph disease) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81181 | ATXN7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81182 | ATXN8OS (ATXN8 opposite strand [non-protein coding]) (eg, spinocerebellar ataxia) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81183 | ATXN10 (ataxin 10) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81184 | CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81185 | CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81186 | CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81187 | CNBP (CCHC-type zinc finger nucleic acid binding protein) (eg, myotonic dystrophy | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81188 | CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; evaluation to | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81189 | CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; full gene sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81190 | CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; known familial | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81191 | NTRK1 (neurotrophic receptor tyrosine kinase 1) (eg, solid tumors) translocation | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81192 | NTRK2 (neurotrophic receptor tyrosine kinase 2) (eg, solid tumors) translocation | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81193 | NTRK3 (neurotrophic receptor tyrosine kinase 3) (eg, solid tumors) translocation | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81194 | NTRK (neurotrophic receptor tyrosine kinase 1, 2, and 3) (eg, solid tumors) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81200 | ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81201 | APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP] | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81202 | APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP] | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81203 | APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP] | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81204 | AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81205 | BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, maple | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81206 | BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81207 | BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81208 | BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; other | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81209 | BLM (Bloom syndrome, RecQ helicase-like) (eg, Bloom syndrome) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81210 | BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81212 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81215 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81216 | CPT codes removed | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81217 | refer to Genetic Testing: BRCA-Related Breast and/or Ovarian Cancer Syndrome | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81218 | CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81219 | CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81220 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81221 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81222 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81223 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81224 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81225 | CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81226 | CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81227 | CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81230 | CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug metabolism) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81231 | CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug metabolism) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81232 | DPYD (dihydropyrimidine dehydrogenase) (eg, 5-fluorouracil/5-FU and capecitabine | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81233 | BTK (Bruton's tyrosine kinase) (eg, chronic lymphocytic leukemia) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81234 | DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81235 | EGFR (epidermal growth factor receptor) (eg, non-small cell lung cancer) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81236 | EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81237 | EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, diffuse large | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81238 | F9 (coagulation factor IX) (eg, hemophilia B), full gene sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81239 | DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81240 | F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81241 | F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene analysis, Leiden | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81242 | FANCC (Fanconi anemia, complementation group C) (eg, Fanconi anemia, type C) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81243 | FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81244 | FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81245 | FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81246 | FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81247 | G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81248 | G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81249 | G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81250 | G6PC (glucose-6-phosphatase, catalytic subunit) (eg, Glycogen storage disease, type | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81251 | GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene analysis, common variants | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81252 | GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81253 | GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81254 | GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (eg, nonsyndromic hearing | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81255 | HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay-Sachs disease) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81256 | HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis, common | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81257 | HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81258 | HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81259 | HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81260 | IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81261 | IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81262 | IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81263 | IGH@ (Immunoglobulin heavy chain locus) (eg, leukemia and lymphoma, B-cell) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81264 | IGK@ (Immunoglobulin kappa light chain locus) (eg, leukemia and lymphoma, B-cell) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81265 | Comparative analysis using Short Tandem Repeat (STR) markers; patient and | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81266 | Comparative analysis using Short Tandem Repeat (STR) markers; each additional | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81267 | Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81268 | Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81269 | HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81270 | JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.Val617Phe | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81271 | HTT (huntingtin) (eg, Huntington disease) gene analysis; evaluation to detect | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81272 | KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81273 | KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81274 | HTT (huntingtin) (eg, Huntington disease) gene analysis; characterization of alleles | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81275 | KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81276 | KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81277 | Cytogenomic neoplasia (genome-wide) microarray analysis, interrogation of genomic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81278 | IGH@/BCL2 (t(14;18)) (eg, follicular lymphoma) translocation analysis, major | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81279 | JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) targeted sequence analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81283 | FNL3 (interferon, lambda 3) (eg, drug response), gene analysis, rs12979860 variant | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81284 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; evaluation to detect abnormal | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81285 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; characterization of alleles (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81286 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; full gene sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81287 | MGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81288 | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81289 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; known familial variant(s) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81290 | MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene analysis, common variants | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81291 | MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81292 | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81293 | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81294 | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81295 | MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81296 | MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81297 | MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81298 | MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81299 | MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81300 | MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81301 | Microsatellite instability analysis (eg, hereditary non-polyposis colorectal cancer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81302 | MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; full | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81303 | MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; known | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81304 | MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81305 | MYD88 (myeloid differentiation primary response 88) (eg, Waldenstrom's | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81306 | NUDT15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81307 | PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81308 | PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81309 | PIK3CA (phosphatidylinositol-4, 5-biphosphate 3-kinase, catalytic subunit alpha) (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81310 | NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, exon 12 variants | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81311 | NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81312 | PABPN1 (poly[A] binding protein nuclear 1) (eg, oculopharyngeal muscular | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81313 | PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81314 | PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81315 | PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81316 | PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81317 | PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81318 | PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81319 | PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary non | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81320 | PLCG2 (phospholipase C gamma 2) (eg, chronic lymphocytic leukemia) gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81321 | PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81322 | PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81323 | PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81324 | PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81325 | PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81326 | PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81327 | SEPT9 (Septin9) (eg, colorectal cancer) promoter methylation analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81328 | SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81329 | SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81330 | SMPD1(sphingomyelin phosphodiesterase 1, acid lysosomal) (eg, Niemann-Pick | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81331 | SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81332 | SERPINA1 (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81333 | TGFBI (transforming growth factor beta-induced) (eg, corneal dystrophy) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81334 | RUNX1 (runt related transcription factor 1) (eg, acute myeloid leukemia, familial | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81335 | TPMT (thiopurine S-methyltransferase) (eg, drug metabolism), gene analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81336 | SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81337 | SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81338 | MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81339 | MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81340 | TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81341 | TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81342 | TRG@ (T cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81343 | PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (eg, spinocerebellar | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81344 | TBP (TATA box binding protein) (eg, spinocerebellar ataxia) gene analysis, evaluation | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81345 | TERT (telomerase reverse transcriptase) (eg, thyroid carcinoma, glioblastoma | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81346 | TYMS (thymidylate synthetase) (eg, 5-fluorouracil/5-FU drug metabolism), gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81347 | SF3B1 (splicing factor [3b] subunit B1) (eg, myelodysplastic syndrome/acute myeloid | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81348 | SRSF2 (serine and arginine-rich splicing factor 2) (eg, myelodysplastic syndrome | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81349 | Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81350 | UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, drug | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81351 | TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81352 | TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; targeted | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81353 | TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; known familial | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81355 | VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81357 | U2AF1 (U2 small nuclear RNA auxiliary factor 1) (eg, myelodysplastic syndrome | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81360 | ZRSR2 (zinc finger CCCH-type, RNA binding motif and serine/arginine-rich 2) (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81361 | HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81362 | HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81363 | HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81364 | HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81370 | HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, -C | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81371 | HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81372 | HLA Class I typing, low resolution (eg, antigen equivalents); complete (ie, HLA-A, -B | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81373 | HLA Class I typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-A, -B | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81374 | HLA Class I typing, low resolution (eg, antigen equivalents); one antigen equivalent | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81375 | HLA Class II typing, low resolution (eg, antigen equivalents); HLA-DRB1/3/4/5 and | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81376 | HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81377 | HLA Class II typing, low resolution (eg, antigen equivalents); one antigen equivalent | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81378 | HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81379 | HLA Class I typing, high resolution (ie, alleles or allele groups); complete (ie, HLA-A | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81380 | HLA Class I typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA-A | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81381 | HLA Class I typing, high resolution (ie, alleles or allele groups); one allele or allele | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81382 | HLA Class II typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81383 | HLA Class II typing, high resolution (ie, alleles or allele groups); one allele or allele | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81400 | Molecular pathology procedure, Level 1 (eg, identification of single germline variant | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81401 | Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or 1 | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81402 | Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10 methylated variants, or | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81403 | Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81404 | Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81405 | Molecular pathology procedure, Level 6 (eg, analysis of 6-10 exons by DNA sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81406 | Molecular pathology procedure, Level 7 (eg, analysis of 11-25 exons by DNA | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81407 | Molecular pathology procedure, Level 8 (eg, analysis of 26-50 exons by DNA | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81408 | Molecular pathology procedure, Level 9 (eg, analysis of >50 exons in a single gene by | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81410 | Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81411 | Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81412 | Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81413 | Cardiac ion channelopathies (eg, Brugada syndrome, long QT syndrome, short QT | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81414 | Cardiac ion channelopathies (eg, Brugada syndrome, long QT syndrome, short QT | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81415 | Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81416 | Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81417 | Exome (eg, unexplained constitutional or heritable disorder or syndrome); re | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81418 | Drug metabolism (eg, pharmacogenomics) genomic sequence analysis panel, must | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81419 | Epilepsy genomic sequence analysis panel, must include analyses for ALDH7A1 | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81422 | Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81425 | Genome (eg, unexplained constitutional or heritable disorder or syndrome) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81426 | Genome (eg, unexplained constitutional or heritable disorder or syndrome) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81427 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); re | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81430 | Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81431 | Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81432 | Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81433 | Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81434 | Hereditary retinal disorders (eg, retinitis pigmentosa, Leber congenital amaurosis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81435 | Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81436 | 2/12/26 Removed deleted codes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81437 | Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81438 | 2/12/26 Removed deleted codes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81439 | Hereditary cardiomyopathy (eg, hypertrophic cardiomyopathy, dilated cardiomyopathy | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81440 | Nuclear encoded mitochondrial genes (eg, neurologic or myopathic phenotypes), genomic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81441 | Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi anemia, dyskeratosis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81442 | Noonan spectrum disorders (eg, Noonan syndrome, cardio-facio-cutaneous syndrome | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81445 | Solid organ neoplasm, genomic sequence analysis panel, 5-50 genes, interrogation | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81448 | Hereditary peripheral neuropathies (eg, Charcot-Marie-Tooth, spastic paraplegia) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81449 | Solid organ neoplasm, genomic sequence analysis panel, 5-50 genes, interrogation | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81450 | Hematolymphoid neoplasm or disorder, genomic sequence analysis panel, 5-50 genes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81451 | Hematolymphoid neoplasm or disorder, genomic sequence analysis panel, 5-50 genes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81455 | Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81456 | Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81457 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81458 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81459 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81460 | Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81462 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81463 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81464 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81465 | Whole mitochondrial genome large deletion analysis panel (eg, Kearns-Sayre | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81470 | X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81471 | X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID) | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81479 | Unlisted molecular pathology procedure | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81490 | Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81493 | Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81500 | Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81503 | Oncology (ovarian), biochemical assays of five proteins (CA-125, apolipoprotein A1 | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81504 | Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81506 | Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81508 | 1/1/25 Template and CCA product update. Code updates: CPT , no longer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81509 | 1/1/25 Template and CCA product update. Code updates: CPT , no longer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81510 | 1/1/25 Template and CCA product update. Code updates: CPT , no longer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81511 | 1/1/25 Template and CCA product update. Code updates: CPT , no longer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81512 | 1/1/25 Template and CCA product update. Code updates: CPT , no longer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81513 | 1/1/25 Template and CCA product update. Code updates: CPT , no longer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81514 | 1/1/25 Template and CCA product update. Code updates: CPT , no longer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81517 | Liver disease, analysis of 3 biomarkers (hyaluronic acid [HA], procollagen III amino | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81518 | Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81519 | Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81520 | Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81521 | Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81522 | Oncology (breast), mRNA, gene expression profiling by RT-PCR of 12 genes (8 | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81523 | Oncology (breast), mRNA, next-generation sequencing gene expression profiling of | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81525 | Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81528 | 1/1/25 Template and CCA product update. Code updates: CPT , no longer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81529 | Oncology (cutaneous melanoma), mRNA, gene expression profiling by real-time RT | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81535 | Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81536 | Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81538 | Oncology (lung), mass spectrometric 8-protein signature, including amyloid A | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81539 | authorization; CPT , do not require prior authorization | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81540 | Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81541 | Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81542 | Oncology (prostate), mRNA, microarray gene expression profiling of 22 content | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81546 | Oncology (thyroid), mRNA, gene expression analysis of 10,196 genes, utilizing fine | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81551 | authorization; CPT , do not require prior authorization | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81552 | Oncology (uveal melanoma), mRNA, gene expression profiling by real-time RT-PCR of | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81554 | Pulmonary disease (idiopathic pulmonary fibrosis [IPF]), mRNA, gene expression | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81595 | Cardiology (heart transplant), mRNA, gene expression profiling by real-time | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81596 | Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| 81599 | Unlisted multianalyte assay with algorithmic analysis | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| L3500 | • : Molecular Pathology Procedures | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3840 | DNA analysis for germline mutations of the RET proto-oncogene for susceptibility to | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3841 | Genetic testing for retinoblastoma | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3842 | Genetic testing for Von Hippel-Lindau disease | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3845 | Genetic testing for alpha-thalassemia | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3846 | Genetic testing for hemoglobin E beta-thalassemia | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3849 | Genetic testing for Niemann-Pick disease | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3850 | Genetic testing for sickle cell anemia | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3853 | Genetic testing for myotonic muscular dystrophy | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3854 | Gene expression profiling panel for use in the management of breast cancer | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3861 | Genetic testing, sodium channel, voltage-gated, type V, alpha subunit (SCN5A) and | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3865 | Comprehensive gene sequence analysis for hypertrophic cardiomyopathy | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3866 | Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |
| S3870 | Comparative genomic hybridization (CGH) microarray testing for developmental | 2019-04-01 | 2019-01-25 | 97% | [PDF] Genetic and Molecular Testing Medical Necessity Guideline |