Molecular Pathology

Molecular pathology services, including genetic testing, are rapidly becoming the standard of care in diagnostic medicine and other related areas. OHCA is committed to ongoing evaluation of the clinical evidence supporting the use of these services to ensure that medically necessary tests and technologies are available to our members.

• Genetic and Molecular Pathology Guidelines (updated 9/25/24)

• FAQ – Molecular Pathology 

• OHCA Fee Schedule  
• Manual Pricing Information

• Click here for information: Medical Authorization Unit

• 6/26/2018: Prior Authorization for Gene Expression Profiling CPT Code
• 3/22/2018: Prior Authorization for Microarray Effective 5/1/2018
• 9/18/2017: Prior Authorization for Cystic Fibrosis Common Mutation Testing
• 7/31/2017: Molecular Pathology Prior Authorization - Effective September 1, 2017
• 7/28/2016: Prior Authorization of Hereditary Cancer Susceptibility Testing
• 1/6/2016: Non-Invasive Prenatal Testing for High-Risk Pregnant Women 
• 12/1/2015: Prior Authorization of 2016 Molecular Pathology Codes
• 9/30/2015: Prior Authorization of Molecular Pathology Codes: HLA Typing
• 5/29/2014: Prior Authorization of Molecular Pathology Codes
• 8/8/2013: Coverage of Carrier Screening
• 7/8/2013:  Amendments to Genetic Testing and Counseling Policy
• 4/8/2013:  Cell-Free Fetal DNA Testing aka Non-Invasive Prenatal Testing (NIPD)
• 1/14/2013:  Billing for Molecular Pathology Codes
• 2/7/2013:  Infectious Agent Detection by Nucleic Acid
• 12/27/2012:  Molecular Pathology CPT Coding Changes and Prior Authorization

• Genetic Testing Physician Request Form
• Attachment Cover Sheet
• Provider Billing & Procedure Manual (Contains instructions for filing attachments to electronic claims)

• Genetic Counseling
• Genetic Testing - 317:30-5-2(a)(1)(F)(F)  

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The OHCA seeks advice and consultation from medical professionals, professional and tribal organizations, and the general public in developing new or amended policies and rules. The proposed rule changes page is designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.

Disclaimer: The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.