Genetic testing

Employee Health Plan

Doctor looking through microscope

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.

  • If you use the WellFirst Health Provider Portal, submit prior authorization requests via the provider portal. 
  • If you do not have access to submit prior authorization via the provider portal, fax the genetic testing prior authorization form to the number indicated on the form. 
Certain tests require pre-test and post- test genetic counseling. Prior authorization is not required for referrals to a genetic counselor.
 
The chart below identifies new medical policy components, which may vary by test. See individual policy for details
Medical PolicyPolicy numberPolicy typeAuthorization RequiredGenetic Counseling Required
General Genetic Testing PolicyMP9012GeneralSome 
Hereditary Cardiac Disease & Arrhythmias MP9472CancerXX
Thrombophilia MP9473General  
Reproductive Carrier Screening & Prenatal Diagnosis MP9477Maternal-fetalSome 
BRCA1 and BRCA2 MP9478CancerXX
Pharmacogenetic Testing MP9479GeneralX 
Polyposis MP9482CancerXX
Multiple Endocrine Neoplasia, Type 1 & 2 MP9483CancerXX
Diffuse Gastric Cancer – CDH1 Gene MP9484CancerXX
Somatic Tumor Markers, Gene Expression Assays for Hematology/Oncology Indications MP9486General  
Lynch Syndrome MP9487CancerXX
Cowden Syndrome – PTEN Gene MP9488CancerXX
Chromosomal Microarray Analysis MP9491General  
Neurologic Disorders MP9497GeneralXX
Stickler SyndromeMP9504GeneralXX
Marfan Syndrome MP9506GeneralXX
Ehlers-Danlos Syndrome MP9505GeneralXX
Maturity onset of the young (MODY) sequencing panel MP9507GeneralXX
Hereditary Cancer Susceptibility MP9521Cancer  
Hereditary Hemorrhagic Telangiectasia (HHT) MP9524GeneralXX
Hypercholesterolemia MP9525GeneralXX
Birt Hogg Dube Syndrome MP9527GeneralXX
Focal Segmental Glomerular Sclerosis MP9543GeneralXX

See covered genetic testing that does not require prior authorization.

All of the above numbered medical policies meet the medical necessity criteria component.

See our full list of genetic testing policies. (coming soon)

Additional Resources