United announces Pre-Authorization for Genetics Testing
United announced that starting 10/1/2017 all genetic (BRACA, PGX, Cancer etc..) testing will require pre-authorization before the sample is collected or payment will not be made. It is the labs responsibility to make sure the ordering physician gets the authorization. This is the new world the labs live in. It follows the Maryland Medicaid decision to require pre-authorization for the top 2 tier (G0482 & G0483) confirmatory drug testing codes. Most insurances will follow suit in 2018. I am accused of being a troll for my other posts on this website. I am not a troll, just in tune to what is going on. Sales Reps need to educate themselves and not rely on the labs. Wake up because the s**t will hit the fan in 2018 especially with PAMA starting at a 10% cut to Medicare Rates. Remember almost all insurances set their rates to a % of Medicare CLFS. And most insurers will require out of network labs to submit claims through a clearinghouse like BeaconLBS in 2018, so most OON claims will get rejected . Time to find in network labs that are full service and dump the toxicology and PGX specialty labs. CMS and the insurers are conspiring to put the specialty tox and PGX labs out of business.