Updated the Prior Authorization Manual-Genetic testing
August 30, 2017Most genetic testing CPT codes have pended for pre-payment review by South Dakota Medicaid. In order to allow providers to more accurately determine if a service will be covered before provision of the service and to simplify claims processing, South Dakota Medicaid is revising this process to require prior authorization for most genetic testing CPT codes. Effective for claims submitted September 1, 2017 genetic testing CPT codes will require a prior authorization. Providers may begin requesting prior authorization immediately. Prior authorization coverage will also be available for Lynch syndrome and other inherited colon cancer syndromes for people with a significant risk beginning in September. Certain tests are exempt from Prior Authorization. The following CPT codes do not require prior authorization from South Dakota Medicaid: 81170, 81206, 81207, 81208, 81218, 81219, 81235, 81242, 81243, 81245, 81246, 81250, 81255, 81256, 81261, 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81270, 81287, 81310, 81315, 81316, 81340, 81341, 81342, 81506, 81507, 81508, 81509, 81510, 81511, and 81595. Please note that all prior authorization request forms have been updated to include a new fax number and email. Remember: SD Medicaid has up to 30 days to make a prior authorization determination; requests are generally completed earlier when sufficient documentation is received.