CurrentUnitedHealthcarePolicy CS151KS.03

Carrier Testing Panels for Genetic Diseases (for Kansas Only)

Customize your policy alerts

Sign up for UnitedHealthcare Policy CS151KS.03 alerts

Get alerted when Policy CS151KS.03 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy governs coverage and use of carrier testing panels for genetic diseases for UnitedHealthcare Community Plan members in Kansas; it references Kansas Medical Assistance Program clinical criteria and applies only to Kansas.

Policy Summary

PayerUnitedHealthcare

PolicyCarrier Testing Panels for Genetic Diseases (for Kansas Only)

Policy CodePolicy CS151KS.03

Change TypeMaterial and informational updates

Effective DateAug 1, 2026

Last ReviewAug 1, 2026

Next Review Date

Key ActionEnsure patient medical records contain legible documentation supporting medical necessity and make records available upon request.

SourceLink

POLICY UPDATE CHANGES

Medical Records Documentation Used for Reviews section added language clarifying documentation expectations for medical necessity reviews.

FDA section updated to reflect the most current information.

Kansas-onlystate applicability

>=9Ashkenazi panel min genes

>=15Expanded severe panel min genes

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentUnitedHealthcarePolicy CS151KS.03

Carrier Testing Panels for Genetic Diseases (for Kansas Only)

Customize your policy alerts

Sign up for UnitedHealthcare Policy CS151KS.03 alerts

Get alerted when Policy CS151KS.03 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerUnitedHealthcare

PolicyCarrier Testing Panels for Genetic Diseases (for Kansas Only)

Policy CodePolicy CS151KS.03

Change TypeMaterial and informational updates

Effective DateAug 1, 2026

Last ReviewAug 1, 2026

Next Review Date

Key ActionEnsure patient medical records contain legible documentation supporting medical necessity and make records available upon request.

SourceLink

POLICY UPDATE CHANGES

Medical Records Documentation Used for Reviews section added language clarifying documentation expectations for medical necessity reviews.

FDA section updated to reflect the most current information.

Kansas-onlystate applicability

>=9Ashkenazi panel min genes

>=15Expanded severe panel min genes

Coverage Determination and Criteria

Coverage Determination

Coverage and medical necessity determined by Kansas Medical Assistance Program

State-mandated criteria: Medical necessity clinical coverage criteria for gene analysis (genetic testing) are determined by the Kansas Medical Assistance Program: Professional Fee-For-Service Provider Manual and must be met for coverage.

Providers must consult the Kansas Medical Assistance Program manual for specific clinical criteria and requirements.

The inclusion of a procedure or diagnosis code in this policy is for informational reference only and does not, by itself, indicate that the service is covered. Coverage and medical necessity are determined by applicable federal and state laws, contractual terms, and program requirements specific to Kansas. Providers must verify member benefits and any plan-specific requirements before performing or billing for services.

Medical record documentation that fully supports the medical necessity of requested services is required and may be requested for review. Documentation must include relevant medical history, physical examination findings, and results of pertinent diagnostic tests or procedures, be legible, and be maintained in the patient’s medical record. Services lacking adequate documentation to support medical necessity may be considered not medically necessary; code listings in this policy are informational and do not guarantee coverage or payment.

Carrier testing panels when clinical criteria in the Kansas Medical Assistance Program manual are met

Covered when ALL of the following are met:

Kansas manual criteria must be met: Clinical criteria for carrier testing panels are those specified in the Kansas Medical Assistance Program manual; coverage is provided only when those state-specified clinical criteria are met.

Providers must reference and document how the patient meets the applicable Kansas Medical Assistance Program criteria.

Procedure Codes and Coding Details

Applicable procedure codes (reference)CPT

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 (includes ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, SMPD1)
81443	Genomic sequence analysis panel for severe inherited conditions, must include sequencing of at least 15 genes (examples listed)
81479	Unlisted molecular pathology procedure

Minimum genes for Ashkenazi panel — example value

Minimum genes (Ashkenazi Jewish-associated disorders panel)>= 9 genes (panel must include sequencing of at least 9 genes including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, SMPD1)

Example named CPT code81412 — Ashkenazi Jewish-associated disorders genomic sequence analysis panel

Intended useCarrier screening for Ashkenazi Jewish-associated disorders (examples: Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay‑Sachs disease)

Minimum genes for expanded severe inherited conditions panel — example value

Minimum genes (expanded severe inherited conditions panel)>= 15 genes (panel must include sequencing of at least 15 genes; examples listed in policy)

Example named CPT code

Provider Requirements, Documentation, and Billing Actions

Prior Authorization

Verify benefits and prior authorization; codes are reference-only

Procedure codes listed in this policy (e.g., 0400U, 81412, 81443, 81479) are provided for reference only. Coverage and payment are determined by federal, state, or contractual requirements and applicable laws; inclusion of a code in this policy does not guarantee coverage or reimbursement. Providers should verify member benefits and any prior authorization requirements with the applicable plan and the Kansas Medical Assistance Program before ordering or billing for services.

Codes included for reference: 0400U, 81412, 81443, 81479
Verify member benefit and prior authorization requirements with the plan and Kansas Medical Assistance Program
Inclusion of a code does not imply a right to reimbursement or guarantee claim payment

Note

Confirm eligibility per Kansas manual and keep records available

Ensure the ordering provider documents and maintains all information needed to support medical necessity and make records available upon request; this policy defers clinical criteria to the Kansas Medical Assistance Program and may require review of records to determine eligibility.

Background and Definitions

This policy defers to the Kansas Medical Assistance Program for the clinical criteria that determine medical necessity for gene analysis and carrier testing panels. Providers should consult the Kansas Professional Fee-For-Service Provider Manual for the specific clinical coverage criteria that must be met for services to be considered medically necessary and eligible for coverage. Laboratories performing genetic testing are regulated under CLIA, and medical records may be requested to verify that applicable criteria are met.

Carrier screening panels (examples) — example panels and associated codes

Expanded carrier screening (example)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

Ashkenazi Jewish-associated disorders panel (example)81412 — Genomic sequence analysis panel; must include sequencing of at least 9 genes (includes ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, SMPD1)

Severe inherited conditions panel (example)81443 — Genomic sequence analysis panel for severe inherited conditions; must include sequencing of at least 15 genes (examples listed)

Unlisted molecular pathology

Not Covered

This policy does not explicitly state that any specific tests or indications are categorically not covered. Determinations about whether a particular test is covered are made based on federal and state requirements and the clinical criteria in the Kansas Medical Assistance Program manual; inclusion of a code in this document is informational and does not itself establish coverage or non-coverage.