Frequently Asked Questions

How does EviCore handle large gene panels?

Most panels require PA. When panels are billed with individual codes for the genes in a panel, we review the medical necessity of each gene within that panel and typically only approves reimbursement for those genes that are medically necessary. In addition, many panels now have a panel-specific CPT code, but some labs are still billing with multiple stacked CPT codes. We will re-direct those panels billed with multiple codes to the appropriate single-CPT panel code. That way, we help ensure plans only pay claims that are appropriately coded.

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