CPT CODES REQUIRING PRIOR AUTHORIZATION

Metro Lab Ordering Unit CodeTest NameCPT Code Metro Lab Ordering Unit CodeTest NameCPT Code10149 Cystic Fibrosis 165 (RET) Gene ,Bld8140550045 FACTOR V LEIDEN (R506Q) MUTATION81241304376 Marfan Syndrome (FBN1) Sequencing8140850055 PROTHROMBIN G 20210A GENE MUTATION81240304420 Cytogenomic SNP(aCGH) Microarray81229157511 FLT3 & NPM1 MUTATION DETECTION81245304580 MCAD Deficiency(ACADM)Sequencing,P81479181403 Bill: RhD Varient Assay81403304585 MCAD(ACADM) 2 Mutations (PCR),P81401181479 Bill: RBC Molecular Phenotype81479305041 BCR-ABL1 Mutation Analysis/NGS81479226022 BILL: INMS Unlisted : DNA seq/pcr81403281240 Billing: F2 Gene81240305355Y Chromosome Microdeletion81403281310 BILL: NPM1 GENE ANALY EXON 12 VAR81310305455 Fragile X (FMR1) w/Rflx Methylation81244290467Y Chromosome Microdeletions/PCR81403305600 Prenatal Testing Fetal Aneuploidy81420292032 CYP2D6 Genotype81226305605 Spinobulbar Musc Atrophy,Kennedy's81401292035 JAK2 V617F Mutation Detect.

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

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