81160
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation showing no known pathogenic or likely pathogenic variant in a first-, second- or third-degree relative
- No documentation requirements (medical records, test results, or clinical notes) are specified in the provided excerpt.
- Inferred: laboratory reports or prior genetic test results showing variants of unknown significance (VUS) or other findings for which RNA analysis is being requested to aid classification.
- No explicit documentation requirements are stated in the provided text.
Key Coverage Criteria
- Testing of multiple genes / multigene panel testing (Billing and Coding: MolDX: Testing of Multiple Genes; MolDX: Defining panel services in MolDX)
- Repeat germline testing where applicable (MolDX: Repeat Germline Testing)
- Congenital hypertrophy of retinal pigment epithelium (CHRPE) (unilateral, bilateral or multifocal) ${ }^{104}; OR
- Cribriform-morular variant of papillary thyroid cancer ${ }^{104}$; OR
- Desmoid tumor ${ }^{104} ;$ OR
- Hepatoblastoma ${ }^{104}$; OR
1 Active Policy
HUMANA-GENETIC-TESTING-FOR-HEREDITARY-COLORECTAL-AND-UTERINE-CANCER-MA — Genetic Testing for Hereditary Colorectal and Uterine Cancer - Medicare Advantage
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