Does S3846 require prior authorization?

No, S3846 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S3846?

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

When available, use CPT tier 1 or tier 2 molecular pathology codes for the specific test; if no CPT code exists for the test, use unlisted molecular pathology code 81479.
Defines first-degree relatives (biological parent, brother, sister, child) and second-degree relatives (biologic grandparent, aunt/uncle, niece/nephew, grandchildren, half-sibling) for use in assessing family history.

Genetic testing to establish a diagnosis or susceptibility for an inherited disease may be considered medically necessary if the genetic test is not a panel test listed in GT64 (Genetic Testing Policy No. 64) and is not addressed by another specific policy; these panel tests are always investigational.
Panel tests listed in the document may be considered medically necessary when they meet Criterion I (with all genes listed in Criterion I) or Criterion IV.

REGENCE-GT20, Genetic and Molecular Diagnostic Testing

REGENCE-GT81, Reproductive Carrier Screening for Genetic Diseases

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