Prior Auth Required

81161 - Genetic Testing Genetic Testing – General (all tests) All genetic testing (incl. but not limited to CPT +; categories below) All

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceGenetic Testing Genetic Testing – General (all tests) All genetic testing (incl. but not limited to CPT +; categories below) All
Procedure / Service Description

Service Category Benefit/Description Codes Requiring Authorization Member Program* - service/diagnosis 15829, 15876, 15877, 15878, 15879, 21087, 21120, 21121, 21122, 21123, 21125, 21127, 21270, 21899, 31899, 40799, 67900 Genetic Testing Genetic Testing – General (all tests) All genetic testing (incl. but not limited to CPT 81161+; categories below) All Gene Analysis & Molecular Pathology 81161–81479 (except 81370–81383) All Chimerism testing (post transplant follow up) 81265, 81267, 81268, 81403, 81450, 88271, 88272, 88273, 88274, 88275, 88364, 88365, 88367, 88368 All

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.