Prior Authorization Information

Prior authorization is a process used by many insurance copanies to determine if a procedure, service, or medication will be covered. Molecular diagnostics, genetic, and some pathology testing often require prior authorization, have medical policy criteria the patient must meet, or may not be covered by an individual’s plan.

Complete form: PRIOR AUTHORIZATION REQUEST FORM
Include a legible copy of the front and back of the patient’s insurance card
Send relevant clinic notes (i.e. ultrasound report, pathology reports, office visits, genetic counseling notes, previous testing, etc.)
Send above information to our Billing Support team by:
- rpsbillingsupport@unmc.edu | fax (402-559-8359)
- If requesting same day prior authorization assistance please notify billing support before 3:00 pm.

What to expect after submitting a request?

An 'Insurance Authorization Update' will be sent in nealry all cases to the ordering provider (by the method designated in section D of the prior auth form).
- Testing automatically proceeds if the out of pocket setimate is $100 or less and the specimen has been received by the laboratory.
The provider/ordering facility is responsible for coordinating specimen collection and shipment to our laboratory after authorization update has been communicated.

What to do if prior authorization is denied or testing is not a covered benefit?

Even if prior authorization is denied or an insurance policy excludes the service for your patient, the patient may still seek testing but will be responsible for the cost of testing. Please also submit the Patient Consent for Non-Covered Lab Services Form. RPS offers financial assistance for patients who meet criteria and you can reach out to our billing team to review payment options.

Who is responsible for obtaining prior authorization?

Providers are responsible for confirming coverage and benefits for any diagnostic testing orders sent to Regional Pathology Services to be billed through insurance. This includes obtaining prior authorizations or requesting prior authorization assistance before samples are collected and sent for processing. Insurance will consider the sample collection date as the date of service, not the date testing is performed. Insurance companies do not typically backdate prior auth requests. Insurance rules dictate that the ordering provider is responsible for denied charges when prior authorization was required but not obtained. Services denied for this reason may be billed as client responsibility.

Please Note: Regional Pathology Services offers prior authorization assistance for tests performed at our facility or at our contracted reference laboratories. Prior authorization requests for non-contracted laboratories and may be billed to client. Please check with our prior authorization specialist at rpsbillingsupport@unmc.edu prior to obtaining a specimen.

Common Testing Requiring Prior Authorization:

Please note this is not an all-inclusive list of tests that require prior authorization or have limited coverge. The patient's insurance company should be contacted for plan specific details.

Test Code	Test Name	CPT Code(s)	UHC Molecular Test Code
AATM	Alpha Antitrypsin Pyrosequencing	81332	56281332
BCRRT	BCR ABL Qualitative	81207	56281207
BCRQNT	BCR ABL Quantitative p210	81206	56281206
BRAF	BRAF Mutation Detection	81210	56281210
CALRM	Calrecticulin Exon 9 Mutations	81219	56281219_CALRM
CEBPA	CEBPA Gene Analysis	81218	CEBPA82
VARIES CODES	Chromosome analysis *see our website for other sample types and their codes	88230,88262, 88262, 88280, 88285 and 88289	n/a
EWNGS	Ewings by RT-PCR	81401	56281401
PROTH	Prothrombin Factor II	81240	56200038A
VARIES CODES	FISH Analysis	88271, 88275	N/A
FLT3	FLT3 ITD Mutation Detection	81245	56281255
FLTTKD	FLT3 TKD Mutation	81479	56200050
FRGX	Fragile X Mutation Analysis, Modified by CE	81243	56281243
GIP	Gastrointestinal Pathogen Panel	87507	GIP
PCRIG	IgH Gene Rearrangement by DNA	81261	56281261
JK2E12	JAK 2 Exon 12 Seq Detection by NGS	81479	56200032_JK2E12
JAK2	JAK2 Mutation Detection by NGS, Qualitative	81479	56281271_JAK2
LEYDN	Leiden Factor V	81241	56200038B
MSI	Micro Satellite Instability	81301	n/a
VARIES CODES	Microarray Analysis	81229	* Molecular testing code differs depending on testing reason/sample type. See our website for specifics
MLH1	MLH1 by PCR	81288	MLH1M87
MPLM	MPL by NGS Mutation Detection	81479	56281339
MYD88/MYDBM	MYD88 Gene Analysis	81305	56200041
MYMPO/MYMPB	Myeloid Mutation Panel	81450	56200036
MPNBM/MPNPB	Myeloproliferative Neoplasm by NGS	81450	56200023
NPM1	NPM1 Mutation	81310	56281310
RESPP	Respiratory Pathogen Panel	0202U	n/a
0020	Rhabdomyosarcoma by RT-PCR	81401	56281407
RHD	RHD Genotype	81403	n/a
STPP	Solid Tumor Precision Panel	81445	56200048
0030	Synovial Sarcoma by RT-PCR	81401	56281408
TGAMA	T Gamma Gene Rearrangement by DNA	81342	56281342
TP53	TP53 Mutation Detection by NGS*	81352	56281352
TMB	Tumor Mutation Burden Assay	81479	56200049
YCMD	Y-Chromosome Micro-Deletion	81403	55801005

* For your patients with commercial United Healthcare insurance plans, we have updated this information on the UHC Test Directory. Please make sure you utilize the updated test codes listed below when requesting prior authorization online.

If you have any questions or need assistance with prior authorizations please contact our billing department at 402-559-9480