CurrentUnitedHealthcarePolicy N/A

Genetic Testing for Hereditary Cancer (for Louisiana Only) — Familial Adenomatous Polyposis eligibility update

UnitedHealthcare medical policy guidance on coverage rationale and eligibility criteria for Familial Adenomatous Polyposis genetic testing and related counseling for Louisiana members; references to state Medicaid manuals may modify coverage.

Policy Summary

PayerUnitedHealthcare

PolicyGenetic Testing for Hereditary Cancer (LA) — FAP eligibility update

Policy CodePolicy N/A

Change TypeRevised eligibility threshold (≥ 20 cumulative adenomas)

Effective DateJune 1, 2025

Next Review Date

Key ActionReview federal, state, or contractual benefit plan coverage terms and any applicable state Medicaid manuals before applying this policy.

SourceLink

POLICY UPDATE CHANGES

Replaced criterion requiring 'personal history of > 20 cumulative adenomas' with 'personal history of ≥ 20 cumulative adenomas'.

Coverage Rationale and Eligibility Criteria for Familial Adenomatous Polyposis were updated (summary of changes).

≥ 20adenomas threshold

CS049LA.Sarchived version

2LA Medicaid refs

Coverage Criteria

Policy Summary

PayerUnitedHealthcare

PolicyGenetic Testing for Hereditary Cancer (LA) — FAP eligibility update

Policy CodePolicy N/A

Change TypeRevised eligibility threshold (≥ 20 cumulative adenomas)

Effective DateJune 1, 2025

Next Review Date

Key ActionReview federal, state, or contractual benefit plan coverage terms and any applicable state Medicaid manuals before applying this policy.

SourceLink

On This Page

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Covered Indications

Familial Adenomatous Polyposis genetic testing when eligibility criteria (including adenoma count) are met

Familial Adenomatous Polyposis genetic testing is covered when the eligibility criteria (including adenoma count) are met. Review applicable state Medicaid guidance for local implementation.

Covered indication: Member meets the policy eligibility criteria for FAP testing, including a personal history of ≥ 20 cumulative adenomas

See Louisiana Medicaid MCO Manual and Professional Services Provider Manual for additional genetic counseling and testing guidance as applicable

Eligibility Requirements

This section is a placeholder. For complete eligibility rules, including any family‑history, prior‑testing, or counseling requirements that may apply to Louisiana members, refer to the full UnitedHealthcare policy and the Louisiana Medicaid MCO Manual cited by the policy.

This is a placeholder for additional eligibility requirements. The supplied chunks did not specify further eligibility elements (for example, detailed family history definitions, timing, or prior testing prerequisites); use the full policy text and applicable state manuals when populating these items.

Provider Actions & Administrative Notes

Prior Authorization

Prior Authorization Guidance

Prior authorization requirements vary by plan. Consult the member's benefit contract and use UnitedHealthcare's plan-specific tools (for example, InterQual) or the payer's provider portal to determine whether prior authorization is required before ordering services. If prior authorization is required, obtain approval in advance to avoid claim denials.

Check member-specific benefit terms and eligibility
Use UnitedHealthcare provider portal or designated prior authorization tool (e.g., InterQual) for submission requirements
Obtain prior authorization before services when required to prevent denial

Note

Provider Resources

If a specific provider action is not described here, refer to UnitedHealthcare plan resources and the provider website for the appropriate administrative steps, submission forms, and contact information.

Visit the payer's provider portal for claim and authorization forms
Contact provider services for plan-specific instructions

Documentation Required

Check Governing Benefit Terms

Review federal, state, and contractual benefit plan coverage terms, including applicable state Medicaid manuals where relevant, before making coverage or billing determinations. Those governing documents supersede this policy when there is a conflict.

Confirm applicability of state Medicaid manual provisions for Medicaid members
Verify federal or contractual requirements that may alter coverage

Prior Authorization

Plan-Specific Governance

Federal, state, or contractual requirements take precedence over this Medical Policy if there is any conflict. Always follow plan-specific governance and regulatory mandates when they differ from the policy content.

When applicable law or contract differs from this policy, follow the law or contract
Document any deviations and the governing authority cited

Note

Louisiana Medicaid — Genetic Counseling & Testing

For providers in Louisiana Medicaid managed care, follow the Louisiana Medicaid MCO Manual for requirements related to genetic counseling and genetic testing. Ensure documentation of counseling and testing complies with state Medicaid guidance prior to submitting claims.

Reference the Louisiana Medicaid MCO Manual for genetic counseling/testing rules
Document counseling in the medical record when required by state guidance

Note

Provider Action — General Reminder

Ensure all required documentation, prior authorizations, and plan forms are completed per the member's plan before submitting claims. When provider actions are unspecified in this policy, rely on the payer's provider communications and portals for final instructions.

Complete and retain all supporting documentation in the medical record
Follow payer guidance for claim submission to reduce denial risk

OpenPayer

Genetic Testing for Hereditary Cancer (for Louisiana Only) — Familial Adenomatous Polyposis eligibility update

Coverage Criteria

Covered Indications

Eligibility Requirements

Coding & Definitions

Provider Actions & Administrative Notes

Background

Not Covered