CPT CODES REQUIRING PRIOR AUTHORIZATION

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Metro Lab Ordering Unit CodeTest NameCPT Code Metro Lab Ordering Unit CodeTest NameCPT Code10149Cystic Fibrosis 165 (RET) Gene ,Bld8140550045FACTOR V LEIDEN (R506Q) MUTATION81241304376Marfan Syndrome (FBN1) Sequencing8140850055PROTHROMBIN G 20210A GENE MUTATION81240304420Cytogenomic SNP(aCGH) Microarray81229157511 FLT3 & NPM1 MUTATION DETECTION81245304580MCAD Deficiency(ACADM)Sequencing,P81479181403 Bill: RhD Varient Assay81403304585MCAD(ACADM) 2 Mutations (PCR),P81401181479Bill: RBC Molecular Phenotype81479305041BCR-ABL1 Mutation Analysis/NGS81479226022BILL: INMS Unlisted : DNA seq/pcr81403281240Billing: F2 Gene81240305355Y Chromosome Microdeletion81403281310BILL: NPM1 GENE ANALY EXON 12 VAR81310305455Fragile X (FMR1) w/Rflx Methylation81244290467Y Chromosome Microdeletions/PCR81403305600Prenatal Testing Fetal Aneuploidy81420292032CYP2D6 G

Beginning November 1, 2017, UnitedHealthcare (UPC) has announced that the following CPT codes will require PRIOR AUTHORIZATION before submitting