Does S3800 require prior authorization?

No, S3800 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S3800?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Providers must reference and use the most up-to-date CPT manuals and professional coding guidance prior to claim submission.
Refer to the Concert Platform for the comprehensive list of registered tests and any required documentation for coverage decisions.

Elevated serum creatine kinase (CK) levels
Member must meet at least one of the additional criteria in section B (section B not included in this fragment)
Same genetic testing when there is progression of weakness after pregnancy.
Same genetic testing when there is a prior diagnosis of inflammatory myopathy that was refractory to immunosuppression.
NOTCH3 sequencing and/or deletion/duplication testing for suspected CADASIL or related cerebrovascular/cognitive disorder (ICD-10: I67.850, F02.80, F02.81).
Genetic testing for hereditary epilepsy, neurodegenerative, or neuromuscular disorders to establish or confirm a diagnosis in patients with signs and/or symptoms of a genetic disorder when clinical evaluation and standard laboratory tests/imaging are non-diagnostic or inconclusive.

CARELON-genetic-testing-for-inherited-conditions-2025-09-20-updated-2026-07-01, Genetic Testing for Inherited Conditions

AMBETTER-CG-Epilepsy-Neurodegen-Neuromusc-DO-2025.1, Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions

REGENCE-GT20, Genetic and Molecular Diagnostic Testing

Ask Backwork about documentation requirements, denial risks, or coverage in your state.