Medi-Cal General Medicine Bulletin 597

Effective for dates of service on or after April 1, 2024, the following gene tests are reimbursable with CPT® code 81404 with an approved Treatment Authorization Requirement (TAR) and/or Service Authorization Request (SAR):

• UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) full gene sequence, and
• SOD1 (superoxide dismutase 1, soluble), full gene sequence

Policy Update for PLA Codes 0342U and 0343

Effective for dates of service on or after April 1, 2024, Proprietary Laboratory Analyses (PLA) codes 0342U (oncology, pancreatic cancer) and 0343U (oncology, prostate cancer) will no longer be Medi-Cal benefits.

Effective for dates of service on or after April 1, 2024, RYR1 gene tests are reimbursable with CPT® codes 81406 (molecular pathology procedure, Level 7) or 81408 (molecular pathology procedure, Level 9). Reimbursement requires an approved Treatment Authorization Request (TAR) with required documentation.

Source: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=general-medicine