Does S3845 require prior authorization?

No, S3845 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S3845?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Providers may be required to submit clinical documentation in support of a request for services. Such documentation must a) accurately reflect the clinical situation at the time of the requested service, and b) sufficiently document the ordering provider’s clinical intent.
The clinical utility of PGT-M is firmly established.
When available, use CPT tier 1 or tier 2 molecular pathology codes for the specific test; if no CPT code exists for the test, use unlisted molecular pathology code 81479.
Defines first-degree relatives (biological parent, brother, sister, child) and second-degree relatives (biologic grandparent, aunt/uncle, niece/nephew, grandchildren, half-sibling) for use in assessing family history.

Genetic testing is considered medically necessary for an individual when ALL the following criteria are met.
The individual is either suspected to have a known genetic condition based on clinical presentation or the individual may be pre-symptomatic but at significant risk based on family history.
The genetic disorder being evaluated has clearly defined gene(s) and pathogenic variants associated with it and the associated test has high sensitivity and specificity to guide clinical decision making.
The genetic testing has established analytical and clinical validity and is performed in an appropriately accredited and certified laboratory.
Alternate, biochemical, or other clinical tests are not available, provide an indeterminate result or are less effective than genetic testing.
The natural history of the disease is associated with significant morbidity and or mortality in affected individuals.

CARELON-genetic-testing-for-inherited-conditions-2024-06-30-updated-01-20-2025, Genetic Testing for Inherited Conditions

REGENCE-GT20, Genetic and Molecular Diagnostic Testing

REGENCE-GT81, Reproductive Carrier Screening for Genetic Diseases

CARELON-genetic-testing-for-inherited-conditions-2025-09-20-updated-2026-04-01, Genetic Testing for Inherited Conditions

Ask Verity about documentation requirements, denial risks, or coverage in your state.