Prior Auth Required

81291 - treatment of a defined medical condition, except when such coverage is required by the

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Servicetreatment of a defined medical condition, except when such coverage is required by the
Procedure / Service Description

necessary for the member only. Prior authorization is required for genetic testing. - 81261; 81262; 81263; 81264; 81265; 81266; 81267; 81268; 81269; 81270; 81271; Excluded Services – Genetic counseling and testing not medically necessary for 81272; 81273; 8274; 81280; 81281; 81282; 81283; 81284; 81285; 81286; 81287; treatment of a defined medical condition, except when such coverage is required by the 81288; 81289; 81290; 81291; 81292; 81293; 81294; 81295; 81296; 81297; 81298; Affordable Care Act. 81299; 81300; 81301; 81302; 81303; 81304; 81305; 81306; 81310; 81311; 81312; 81313; 81314; 81315; 81316; 81317; 81318; 81319; 81320; 81321; 81322; 81323;

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.