Genomic Medicine at UC Davis MIND Institute
Use the guidelines on this page to refer patients to UC Davis MIND Institute for genomic medicine specialty care.
To help expedite your referral, include:
- Subspecialty or clinical indication
- Required clinical documentation
- Approved CPT codes
Subspecialty or Indication
Reason for Referral
- Evaluation or Management of Known Genetic Condition
Required Medical Records
- Clinical notes related to condition
- Genetic testing results
NOTE: Direct to consumer testing not accepted.
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
- 96041 x4 (Commercial plans)
Reason for Referral
- Genetic Test Result Discussion
Required Medical Records
- Genetic testing results
NOTE: Direct to consumer testing not accepted.
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
Reason for Referral
- Genetic Counseling for Abnormal Genetic Testing Result
Required Medical Records
- Genetic testing results
NOTE: Direct to consumer testing not accepted.
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
- 96041 x4 (Commercial plans)
Reason for Referral
- Consultation or Evaluation for Family History of a Genetic Condition
Required Medical Records
- Clinical notes related to the condition
- Past family member genetic testing strongly encouraged
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
- 96041 x4 (Commercial plans)
NOTE: If patient has Medicare, ICD10 cannot be a Z-code.
Reason for Referral
- Evaluation for Connective Tissue Disorder
Required Medical Records
- Records list to be determined
- Connective Tissue Disorder referral form required
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
- 96041 x4 (Commercial plans)
-
If the suspected genetic condition is not listed below, provide general reason for referral and use the following guidelines to refer a patient for evaluation or consultation.
Required Medical Records
- Clinical notes related to condition
- Imaging related to condition
- Lab work documenting clinical concerns
- Genetic testing results
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
- 96041 x4 (Commercial plans)
-
Reason for Referral
- Cardiac abnormality: structural, cardiomyopathy, arrythmia
Required Medical Records
- Clinical notes related to condition
- Echocardiogram
- EKG if available
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
-
Reason for Referral
- Ocular condition
Required Medical Records
- Clinical notes related to condition
- Eye exam from optometry or ophthalmology
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
- 96041 x4 (Commercial plans)
-
Reason for Referral
- Rasopathy: Neurofibromatosis Type 1, Noonan syndrome, Cardiofaciocutaneous syndrome
- Tuberous Sclerosis, PTEN-related conditions
Required Medical Records
- Clinical notes related to condition
- Imaging related to condition
- Lab work related to condition
- Genetic testing results
- Ophthalmology evaluation if available
- Dermatology evaluation if available
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
-
Reason for Referral
Suspected hereditary cancers:
- Cancer under the age of 50
- Lynch syndrome
- Hereditary breast and ovarian cancer
- Family history of cancer (any type)
Not treated in Genomic Medicine. Please direct referral to UC Davis Comprehensive Cancer Center.
- Cancer under the age of 50
-
Reason for Referral
For genetic consultations or evaluations related to:
- Current pregnancy
- Ongoing pregnancy
- Multiple pregnancy losses
- Family planning
- Carrier of genetic disorder
- Carrier testing
- Carrier screening
Not treated in Genomic Medicine. Please direct referral to Maternal Fetal Medicine at UC Davis Health.
-
Reason for Referral
- Huntington’s Disease
- Family History of Huntington’s Disease
- Huntington’s Chorea
- Genetic testing for Huntington’s Disease
- HTT gene mutation
Not treated in Genomic Medicine. Please direct referral to UC Davis Health Department of Neurology.
Reason for Referral
- MTHFR mutation
- Folate deficiency
Required Medical Records
Recent labs including:
- B12 vitamin Level
- Total Homocysteine Levels — must be abnormal for acceptance
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
- 96041 x4 (Commercial plans)
-
Reason for Referral
- Family History of Alzheimer’s or Dementia
- Personal History of Alzheimer’s Disease
Required Medical Records
- Clinical notes related to condition
- Genetic testing results
Requested CPT Codes
- 99205
- 99215 x3
- 99417
- 99354
- 99358
- S0265 x8 (Medi-Cal)
- 96040 x4 (Commercial plans)
- 96041 x4 (Commercial plans)
NOTE: If patient has Medicare, ICD10 cannot be a Z-code.
-
Reason for Referral
- APOE mutation
- APOE polymorphism
- APOE testing
Not treated in Genomic Medicine: Please direct referral to UC Davis Health. Appropriate department to be determined.
Reason for Referral
- Adverse medication interaction
- Failed medications
- Pharmacogenetic testing
- Pharmacogenomic testing
- SSRI testing
- GeneSight testing
Not treated in Genomic Medicine: Please direct referral to UC Davis Health. Appropriate department to be determined.
Reason for Referral
- HFE mutation
- HFE polymorphism
- Iron overload
- HFE heterozygote
- HFE homozygote
Not treated in Genomic Medicine: Please direct referral to UC Davis Health, Division of Gastroenterology and Hepatology.
Authorization Information
| Clinic Location | Tax ID | NPI |
|---|---|---|
| Hospital | 946036494 | 1710918545 |