UHC Commercial- Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions)

Synopsis: Update effective 4/1/2024

Documentation Requirements:

• Updated list of CPT codes with associated documentation requirements; added 0265U, 0335U, 0336U, 0425U, and 0426U

Updated list of required clinical information:

• Added: Any relevant metabolic disease laboratory results For prenatal testing, in addition to the above, also include: Source of the sample Fetal ultrasound findings
• Removed: Ethnicity/ancestry (e.g., Ashkenazi Jewish), if reason for testing Genetic counseling (if available)
• Replaced: “any prior genetic testing results” with “all prior genetic testing results”

Applicable Codes:

• Added CPT codes 0260U, 0264U, 0266U, and 0267U
• Removed CPT code 0036U

Source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/index/commercial/whole-exome-and-whole-genome-sequencing-04012024.pdf