Molecular Pathology/Genetic Testing Reported with Unlisted Codes
This policy governs when molecular pathology and genetic testing services reported with unlisted procedure codes (e.g., CPT 81479/81599) are considered reasonable and necessary for UnitedHealthcare Medicare Advantage members, and provides coverage rationale, applicable codes, and test-specific guidance.
Coverage Rationale and Covered Indications for CPT Code 81479 were updated to include Biomarkers for Oncology.
Revised list of covered tests; added specific genes (SDHB, SDHC, SDHD, VHL) under CPT 81479.
Non-covered indications list was revised to add PancraGEN (Powered by Pathfinder TG) as not covered under CPT 81479.
Diagnosis code lists associated with CPT 81479 were modified with additions including C83.1A, Z85.72, C70.0, C80.2, and D75.821 in various CPT 81479 contexts.
Clinical Evidence and References sections were updated and the previous policy version MMP383.23 was archived.
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