Prior Authorization
Cigna Prior Authorization for CPT 81212
Genetic test for BRCA1 and BRCA2 specific founder mutations · Standard commercial plans
Source
Cigna Lab Management Prior Authorization CPT Code List - Effective 05/15/2026Not 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
Cigna/EviCore Cigna Lab Management Prior Authorization CPT Code List - Effective 05/15/2026 lists 81212 as requiring prior authorization for commercial plans, effective 2026-05-15. Confirm member benefit, plan model, and delegated workflow before submission.
Documentation checklist
- ✓Clinical notes supporting medical necessity
- ✓Relevant diagnostic, imaging, lab, or treatment records for the requested service
2026 Medicare rate for CPT 81212
CPT 81212 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 81212 code page for pricing detail.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical notes supporting medical necessity, Relevant diagnostic, imaging, lab, or treatment records for the requested service.
- 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 Cigna require prior authorization for CPT 81212?
- Yes. Cigna requires prior authorization for CPT 81212 (Genetic test for BRCA1 and BRCA2 specific founder mutations) under Standard commercial plans per its published clinical policy.
- What documentation does Cigna require for CPT 81212?
- Clinical notes supporting medical necessity; Relevant diagnostic, imaging, lab, or treatment records for the requested service
- What if Cigna denies the PA for CPT 81212?
- 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 Cigna PA lookups
CPT 81212 prior authorization by payer
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