CurrentUnitedHealthcarePolicy CS151KS.02

Carrier Testing Panels for Genetic Diseases (for Kansas Only)

State-specific UnitedHealthcare medical policy for carrier testing panels for genetic diseases applicable only to Kansas; refers to Kansas Medical Assistance Program Professional Fee-for-Service Provider Manual for medical necessity criteria and provides applicable procedure codes for reference.

Policy Summary

PayerUnitedHealthcare

PolicyCarrier Testing Panels for Genetic Diseases (for Kansas Only)

Policy CodePolicy CS151KS.02

Change TypeSupporting information updated

Effective DateJul 1, 2025

Next Review Date

Key ActionProviders must refer to and document adherence to the Kansas Medical Assistance Program Professional Fee-for-Service Provider Manual for medical necessity criteria when requesting coverage for genetic carrier testing.

SourceLink

POLICY UPDATE CHANGES

Supporting Information - Updated References section to reflect the most current information; archived previous policy version CS151KS.01.

1State-specific policy (Kansas only)

4Reference procedure codes listed

Coverage Summary

State-specific UnitedHealthcare medical policy for Carrier testing panels for genetic diseases applicable only to Kansas. Policy Number: CS151KS.02. Status: CURRENT. Effective Date: July 1, 2025; Last Review: July 1, 2025. This policy provides Kansas-specific guidance and references the Kansas Medical Assistance Program Professional Fee-for-Service Provider Manual for medical necessity criteria.

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Medical Necessity / Coverage Reference

Coverage and Medical Necessity Reference

Coverage determinations and medical necessity criteria for gene analysis (genetic testing):

ALL of the following

This Medical Policy only applies to the state of Kansas.
For medical necessity clinical coverage criteria for gene analysis (genetic testing), refer to the Kansas Medical Assistance Program Professional Fee-for-Service Provider Manual.
Listing of a code in this policy does not imply the service described is covered or non-covered; benefit coverage determined by federal, state, or contractual requirements and applicable laws.

ref

title

Operationally, this policy directs providers to the Kansas Medical Assistance Program Professional Fee-for-Service Provider Manual for medical necessity clinical coverage criteria for gene analysis (genetic testing). Providers must refer to and document adherence to that state manual when requesting coverage for genetic carrier testing. The procedure code listings included in this policy are provided for reference only and do not guarantee coverage or reimbursement; verify applicable federal, state, or contractual requirements prior to billing.

Provider Actions & Billing Guidance

Documentation Required

Follow state reference for medical necessity

Providers must refer to and document adherence to the Kansas Medical Assistance Program Professional Fee-for-Service Provider Manual for medical necessity criteria when requesting coverage for genetic carrier testing.

0400U
81412
81443
81479

Billing Rule

Code listing is for reference only

The listing of procedure and/or diagnosis codes in this policy is provided for reference only and does not imply that the service described is covered or non-covered, nor does it guarantee reimbursement; verify federal, state, or contractual requirements prior to billing.

0400U
81412
81443
81479

Reference Procedure Codes

Reference procedure codes (provided for reference only)CPT|HCPCS|mixed

0400U	Obstetrics (expanded carrier screening), 145 genes by next generation sequencing, fragment analysis and multiplex ligation dependent probe amplification, DNA, reported as carrier positive or negative.
81412	Ashkenazi Jewish associated disorders genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1.
81443	Genetic testing for severe inherited conditions genomic sequence analysis panel, must include sequencing of at least 15 genes (e.g., ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH).
81479	Unlisted molecular pathology procedure.

Note: The listing of procedure and diagnosis codes in this policy is for reference only and does not imply that the services described are covered or non-covered. Coverage and reimbursement are determined by federal, state, or contractual requirements and applicable laws; inclusion of a code does not guarantee payment.

Background & Regulatory Context

Background: This Kansas-specific policy is intended to guide interpretation of UnitedHealthcare standard benefit plans in the state of Kansas and to point providers to the Kansas Medical Assistance Program Provider Manual for medical necessity determinations. Laboratories that perform genetic tests are regulated under the Clinical Laboratory Improvement Amendments (CLIA) Act of 1988, and CLIA requirements apply to testing laboratories and should be considered alongside state requirements. When deciding coverage, federal, state, or contractual requirements govern and may differ from standard benefit plan terms.

Source	Reference
Reference manual	Kansas Medical Assistance Program Professional Fee-for-Service Provider Manual (accessed May 13, 2025)
Regulation	Clinical Laboratory Improvement Amendments (CLIA) Act of 1988 (FDA informational link provided)