Policy details

  • Current Medical Policy MP9012 serves as the general policy for genetic testing and will provide links to specific genetic tests.
  • If a medical policy does not refer to a specific genetic test, applicable evidenced based guidelines and a prior authorization will be required.
  • Authorization, genetic counseling and medical necessity requirements may be test specific, as identified within each medical policy.
  • Medical necessity criteria will be applied.
For services that require authorization, submit prior authoization requests via the WellFirst Health provider portal

View a list of genetic tests that require prior authorization.

Providers without portal access may fax the genetic testing prior authorization form to the number indicated on the form. 

For laboratories only—Every genetic test is assigned a genetic testing unit (GTU), a unique alphanumeric identifier for payers who utilize Concert Genetic services. This unique GTU may be found on the Concert Genetic Platform. Every genetic test has been assigned a GTU. Log in at concertgenetics.com to find the GTU for the genetic test you are requesting.
Certain tests require pre-test and post- test genetic counseling. Prior authorization is not required for referrals to a genetic counselor.

See our full list of genetic testing policies. 

Additional resources