Prior Auth Required

81416 - Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceExome (eg, unexplained constitutional or heritable disorder or syndrome); sequence
Procedure / Service Description

Genetic and Molecular Testing Medical Necessity Guideline - 81415 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis 81416 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) (List separately in addition to code for primary procedure)

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.