United Healthcare Prior Authorization Facsimile Request Form - Genetic Testing For Brca Mutations Page 7

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CPT Codes for UHC FORM

This is a quick guide to selecting the correct CPT codes on page 4.

Test Code

Test Name

UHC CPT Codes to be Selected

B361

BRCA1/BRCA2 Ashkenazi Founder Panel

81212

B362

BRCA1/BRCA2 Sequencing and Deletion

81211 & 81213

B273

Breast/Ovarian Cancer Panel

81211 & 81213

J055

Breast Cancer High/Moderate Risk Panel

81211 & 81213

J005

Breast Cancer High Risk Panel and PALB2

81211 & 81213

B521

Breast Cancer High Risk Panel

81211 & 81213

B275

Comprehensive Cancer Panel

81211 & 81213

B751

High/Moderate Risk Panel

81211 & 81213

B344

Endometrial Cancer Panel

81211 & 81213

B343

Pancreatic Cancer Panel

81211 & 81213

B370

BRCA1 Known Variant

81215

B372

BRCA2 Known Varian

81217

B749

If BRCA1/2 is selected

81211 & 81213

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