Molecular Pathology Policy, Frequently Asked Questions - Reimbursement Policy - UnitedHealthcare Commercial Plans

Overview

The goal of the Molecular Pathology Reimbursement Policy is to bring clarity, consistency and transparency to molecular diagnostics/genetic testing claims adjudication. Claim edits have been developed to help ensure correct coding for claims submitted that have not obtained an authorization through the Genetic and Molecular Testing Prior Authorization (GMTPA) program. These edits and requirements are outlined in this Network Bulletin article (page 18) and are available in the Reimbursement Policy.

Claims subjected to authorization requirements through the GMTPA program will be managed through updates to the lab’s registration with Beacon Laboratory Benefit Solutions, Inc. (BeaconLBS®).1 Tests will need to be updated on a consistent basis to reflect the new coding requirements, as outlined in the policy.

The National Institute of Health (NIH) launched the Genetic Testing Registry (GTR), a free online resource that provides a centralized location for comprehensive genetic test information that is voluntarily submitted by test providers. The intended audience for the GTR is health care providers and researchers.2

The following are answers to some frequently asked questions regarding the Genetic Test Registry (GTR) ID, billing and reimbursement and the Molecular Pathology Reimbursement Policy.

Policy Codes

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  • 01680
  • 81479
* COMM-Molecular-Pathology-Policy-FAQ.pdf
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