Date Posted: 10/10/2022
Starting Jan. 15, 2023, the EmblemHealth Preauthorization List will include the four genetic/molecular testing services shown in the table below.
New Codes Requiring Preauthorization Starting Jan. 15, 2023
| CPT/HCPCS Code | CPT/HCPCS Code Description |
|---|---|
| 0012M | Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative PCR of five genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2), utilizing urine; algorithm reported as a risk score for having urothelial carcinoma. |
| 0013M | Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative PCR of five genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2), utilizing urine; algorithm reported as a risk score for having recurrent urothelial carcinoma. |
| 0014U | Hematology (hematolymphoid neoplasia), gene rearrangement detection by whole genome next-generation sequencing, DNA, whole blood or bone marrow, report of specific gene rearrangement(s). |
| 0017M | Oncology (diffuse large B-cell lymphoma [DLBCL]), mRNA, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue; algorithm reported as cell of origin. |
