Prior Authorization
Aetna Prior Authorization for CPT 81415
Genetic and molecular testing including BRCA gene testing · Standard commercial plans
Source
Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Aetna lists this code under Services that require precertification: Whole exome sequencing. The list states listed services require precertification for members with plans applicable to the list, subject to listed exceptions. Evidence: PDF p.12, Services that require precertification, item 41.
Documentation checklist
- ✓Completed genetic testing precertification request
- ✓Medical records requested for Aetna clinical review
2026 Medicare rate for CPT 81415
CPT 81415 is not priced under the 2026 Medicare Physician Fee Schedule (status X) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT 81415 code page for pricing detail.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Completed genetic testing precertification request, Medical records requested for Aetna clinical review.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Aetna require prior authorization for CPT 81415?
- Yes. Aetna requires prior authorization for CPT 81415 (Genetic and molecular testing including BRCA gene testing) under Standard commercial plans per its published clinical policy.
- What documentation does Aetna require for CPT 81415?
- Completed genetic testing precertification request; Medical records requested for Aetna clinical review
- What if Aetna denies the PA for CPT 81415?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Aetna PA lookups
CPT 81415 prior authorization by payer
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