Does S3842 require prior authorization?

No, S3842 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S3842?

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

Backwork Sign up free

`S3842`, Genetic testing for von hippel-lindau disease

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Clinical documentation of the affected individual's cancer diagnosis when applicable.
Documentation of clinical rationale showing the test is clinically warranted and appropriately applied.

Genetic test report documenting the specific familial pathogenic/likely pathogenic (P/LP) variant and evidence of the relationship to the relative with the variant.

Key Coverage Criteria

Personal history of metastatic prostate cancer.
Personal history of high- or very-high-risk group prostate cancer.
Multiple primary breast cancers (diagnosed synchronously or metachronously).
Personal history of breast cancer AND Ashkenazi Jewish ancestry.
Personal history of breast cancer AND one or more close relatives with exocrine pancreatic cancer.
First-degree relative with a confirmed diagnosis of Birt‑Hogg‑Dubé syndrome (BHDS).

4 Active Policies

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

CARELON-hereditary-cancer-testing-2026-04-04-updated-2026-07-01, Hereditary Cancer Testing

AMBETTER-CG-Hered-CA-Suscep-2025.1, Concert Genetic Testing: Hereditary Cancer Susceptibility

REGENCE-GT20, Genetic and Molecular Diagnostic Testing

Have a follow-up question?

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

Ask Backwork about S3842 Sign up free

S3842, Genetic testing for von hippel-lindau disease