Skip To: Main content|Subnavigation|
Minnesota Department of Human Services Provider Manual
Advanced Search|  

Laboratory Authorization Code List

Revised: 02-16-2016

MHCP fee-for-service requires an authorization for laboratory procedure codes listed below.

Genetic Modifiers:
OA – BRCA1 (Hereditary breast/ovarian cancer)
OB – BRCA2 (Hereditary, breast cancer)

Laboratory Authorization Code List

Code

Description

81211

BRCA1 & BRCA2 full sequence & duplicate/deletion variants

81212

BRCA1 & BRCA2 185delAG, 5285insC & 6174delT

81213

BRCA1 & BRCA2 uncommon duplicate/deletion variants

81214

BRCA1 full sequence & duplicate/deletion variants

81215

BRCA1 known familial variant

81216

BRCA2 full sequence

81432

Hereditary breast cancer-related disorders DOS 1/1/16 forward

81433

Hereditary breast cancer-related disorders DOS 1/1/16 forward

81217

BRCA2 known familial variant

83015

Heavy metal screen through ddf

83018

Quantitative screen metals

83890 0A, 0B

Molecular isolate or ext

83891 0A, 0B

Molecular isolate nucleic

83892 0A, 0B

Molecular enzymatic digest

83893 0A, 0B

Molecular dot/slot/blot

83894 0A, 0B

Molecular electrophoresis

83896 0A, 0B

Molecular nucleic acid probe

83897 0A, 0B

Molecular nucleic acid trans

83898 0A, 0B

Molecular AMP target, ea

83900 0A, 0B

Molecular AMP target, < 2

83901 0A, 0B

Molecular AMP target, > 2

83902 0A, 0B

Molecular reverse transcript

83903 0A, 0B

Molecular mutation scan

83904 0A, 0B

Molecular mutation identify

83905 0A, 0B

Molecular id transcription

83906 0A, 0B

Molecular id translation

83907 0A, 0B

Lysis cells nucleic extraction

83908 0A, 0B

Nucleic acid, signal AMP

83909 0A, 0B

Nucleic acid, high resolute

86343

Leukocyte histamine (LHR)

S3818

BRCA1 Gene Analysis

S3819

BRCA2 Gene Analysis

S3820

Complete BRCA1 & BRCA2

S3822

Single-Mutation Analysis

Refer to BRCA Genetic Mutation Testing for Breast and Ovarian Cancer Susceptibility: Authorization Criteria for specific standards and the MHCP authorization policy and process.

CPT codes, descriptions and other data only are copyright 2009 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.

Rate/Report this pageReport/Rate this page

© 2017 Minnesota Department of Human Services Updated: 8/31/17 2:08 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 8/31/17 2:08 PM