Important Note

If a patient presents to the laboratory for a blood draw and has an order that is marked with a red X, indicating that it is not authorized, please follow the below guidance. 

• Patients with Medicare as their primary insurance do not require pre-auth for lab testing. Any Medicare Advantage, Medicaid, or VA/Tricare plans or Medicare as supplemental insurance will require pre-auth. 
   
• If the test is a built (e.g., NOT a miscellaneous test/ Lab4300) test in Epic and flags as needing authorization, authorization is required. Call the STAT auth line 208-625-5495 if the patient is there.
  • Examples include: Jak2, BCR/ABL, celiac cascade, pancreatic elastase
• For Miscellaneous Tests:
  • If the test is a genetic/molecular test, authorization is likely required. Call the STAT auth line and provide the CPT and performing lab information.
    • These tests will often require whole blood as the specimen type. 
  • If the test has a CPT code listed that ends in a U, assume that authorization is required. Those codes are PLA (proprietary lab analysis) codes that are for newer tests that are only done by specific labs/instruments. PLA codes are used until a real CPT code is assigned  when the testing is more widely adopted. Some insurances are more likely to consider it experimental and not cover testing when a PLA code is used, so prior authorization should be pursued. 
  • If the test is a serum/plasma/urine test, authorization is most likely not required. Proceed with specimen collection. 
    • Examples: PT217, urine myoglobin, testosterone
• For kit tests going to Natera or Myriad Genetics, all prior authorizations are taken care of by the performing laboratory, and authorization by KH is not required. 

For any questions, please consult the Ordering Questions chat in Microsoft Teams.