-
Date of Service and Effective Date of the Authorization Period
Effective 07/01/2020
-
Information Requirements for Medical Necessity Review
Effective 07/01/2020
-
Molecular Pathology Tier 2 Molecular CPT Codes
Effective 07/01/2020
-
Unique Test Identifiers for Non-Specific Procedure Codes
Effective 07/01/2020
-
Confirmatory Genetic Testing
Effective 07/01/2020
-
Genetic Testing by Multigene Panels
Effective 07/01/2020
-
Genetic Presymptomatic and Predictive Testing for Adult-Onset Conditions in Minors
Effective 07/01/2020
-
Genetic Testing for Cancer Susceptibility and Hereditary Cancer Syndromes
Effective 07/01/2020
-
Genetic Testing for Carrier Status
Effective 07/01/2020
-
Genetic Testing for Known Familial Mutations
Effective 07/01/2020
-
Genetic Testing for Non-Medical Purposes
Effective 07/01/2020
-
Genetic Testing for Prenatal Screening and Diagnostic Testing
Effective 07/01/2020
-
Genetic Testing for the Screening, Diagnosis, and Monitoring of Cancer
Effective 07/01/2020
-
Genetic Testing for Variants of Uncertain Clinical Significance
Effective 07/01/2020
-
Genetic Testing to Diagnose Non-Cancer Conditions
Effective 07/01/2020
-
Genetic Testing to Predict Disease Risk
Effective 07/01/2020
-
Hereditary (Germline) Testing After Tumor (Somatic) Testing
Effective 07/01/2020
-
Investigational and Experimental Molecular and Genomic Testing
Effective 10/01/2020
-
Pharmacogenomic Testing for Drug Toxicity and Response
Effective 07/01/2020
-
Preimplantation Genetic Screening and Diagnosis
Effective 07/01/2020
-
4Kscore for Prostate Cancer Risk Assessment
Effective 07/01/2020
-
ABL Tyrosine Kinase Sequencing for Chronic Myeloid Leukemia
Effective 07/01/2020
-
Afirma Thyroid Cancer Classifer Tests
Effective 10/01/2020
-
AlloMap Gene Expression Profiling For Heart Transplant Rejection
Effective 07/01/2020
-
AlloSure for Kidney Transplant Rejection
Effective 07/01/2020
-
Alpha-1-Antitrypsin Deficiency Testing
Effective 07/01/2020
-
Amyotrophic Lateral Sclerosis (ALS) Genetic Testing
Effective 07/01/2020
-
Acute Myeloid Leukemia (AML) Genetic Testing
Effective 07/01/2020
-
Angelman Syndrome Testing
Effective 07/01/2020
-
Anser Testing
Effective 07/01/2020
-
APOE Variant Analysis for Alzheimer Disease
Effective 07/01/2020
-
Ashkenazi Jewish Carrier Screening
Effective 07/01/2020
-
Ataxia-Telangiectasia Testing
Effective 07/01/2020
-
BCR-ABL Negative Myeloproliferative Neoplasm Testing
Effective 07/01/2020
-
BCR-ABL Testing for Chronic Myeloid Leukemia
Effective 07/01/2020
-
Bloom Syndrome Testing
Effective 07/01/2020
-
BRAF Testing for Colorectal Cancer
Effective 07/01/2020
-
BRAF Testing for Melanoma Kinase Inhibitor Response
Effective 07/01/2020
-
BRCA Analysis
Effective 07/01/2020
-
BRCA Ashkenazi Jewish Founder Mutation Testing
Effective 07/01/2020
-
Breast Cancer Index for Breast Cancer Prognosis
Effective 07/01/2020
-
Brugada Syndrome Genetic Testing
Effective 07/01/2020
-
CADASIL Testing
Effective 07/01/2020
-
Canavan Disease Testing
Effective 07/01/2020
-
CellSearch Circulating Tumor Cell Count for Breast Cancer Prognosis
Effective 07/01/2020
-
Charcot-Marie-Tooth Neuropathy Testing
Effective 07/01/2020
-
CHARGE Syndrome Genetic Testing
Effective 07/01/2020
-
Chromosome Analysis for Blood and Bone Marrow
Effective 07/01/2020
-
Chromosome Analysis for Reproductive Disorders, Prenatal Testing, and Developmental Disorders
Effective 07/01/2020
-
Chromosomal Microarray for Prenatal Diagnosis
Effective 07/01/2020
-
Chromosomal Microarray Testing For Developmental Disorders
Effective 07/01/2020
-
Cologuard Screening for Colorectal Cancer
Effective 07/01/2020
-
ConfirmMDx for Prostate Cancer Risk Assessment
Effective 07/01/2020
-
Cxbladder
Effective 07/01/2020
-
CYP2C19 Variant Analysis for Clopidogrel Response
Effective 07/01/2020
-
CYP2C9, VKORC1, and CYP4F2 Testing for Warfarin Response
Effective 07/01/2020
-
CYP2D6 Variant Analysis for Drug Response
Effective 07/01/2020
-
Cystic Fibrosis Testing
Effective 07/01/2020
-
Decipher Prostate Cancer Classifier
Effective 07/01/2020
-
DecisionDx Uveal Melanoma
Effective 07/01/2020
-
Dentatorubral Pallidoluysian Atrophy Testing
Effective 07/01/2020
-
DermTech Pigmented Lesion Assay
Effective 07/01/2020
-
DPYD Variant Analysis for 5-FU Toxicity
Effective 07/01/2020
-
Duchenne and Becker Muscular Dystrophy Testing
Effective 10/01/2020
-
EGFR Testing for Non-Small Cell Lung Cancer TKI Response
Effective 07/01/2020
-
Ehlers-Danlos Syndrome Testing
Effective 07/01/2020
-
EndoPredict for Breast Cancer Prognosis
Effective 07/01/2020
-
Early Onset Familial Alzheimer Disease (EOFAD) Genetic Testing
Effective 07/01/2020
-
Exome Sequencing
Effective 10/01/2020
-
Expanded Carrier Screening Panels
Effective 07/01/2020
-
Factor II/Prothrombin Testing for Thrombophilia
Effective 07/01/2020
-
Factor V Leiden Testing for Thrombophilia
Effective 07/01/2020
-
Familial Adenomatous Polyposis Testing
Effective 07/01/2020
-
Familial Hypercholesterolemia Genetic Testing
Effective 07/01/2020
-
Familial Malignant Melanoma Testing
Effective 07/01/2020
-
FibroTest/FibroSURE
Effective 07/01/2020
-
Flow Cytometry
Effective 07/01/2020
-
FMR1-Related Disorders (Fragile X) Genetic Testing
Effective 07/01/2020
-
FoundationOne CDx
Effective 07/01/2020
-
Friedreich's Ataxia Genetic Testing
Effective 07/01/2020
-
Gaucher Disease Testing
Effective 07/01/2020
-
GeneSight Psychotropic Test
Effective 07/01/2020
-
Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy
Effective 07/01/2020
-
Genetic Testing for Autism
Effective 07/01/2020
-
Genetic Testing for Dilated Cardiomyopathy
Effective 07/01/2020
-
Genetic Testing for Epilepsy
Effective 07/01/2020
-
Genetic Testing for Facioscapulohumeral Muscular Dystrophy
Effective 07/01/2020
-
Genetic Testing for Hereditary Pancreatitis
Effective 07/01/2020
-
Genetic Testing for Limb Girdle Muscular Dystrophy
Effective 07/01/2020
-
Genetic Testing for Nonsyndromic Hearing Loss and Deafness
Effective 07/01/2020
-
Genitourinary Conditions: Molecular Testing
Effective 07/01/2020
-
Molecular Gastrointestinal Pathogen Panel (GIPP) Testing
Effective 07/01/2020
-
GPS Cancer (NantHealth)
Effective 07/01/2020
-
Hemoglobinopathies Genetic Testing
Effective 07/01/2020
-
Hereditary Ataxia Multigene Panel Testing
Effective 10/01/2020
-
Hereditary Cancer Syndrome Multigene Panels
Effective 07/01/2020
-
Hereditary Connective Tissue Disorder Testing
Effective 07/01/2020
-
Hereditary Hemochromatosis Testing
Effective 07/01/2020
-
HIV Tropism Testing for Maraviroc Response
Effective 07/01/2020
-
HLA Typing for Celiac Disease
Effective 07/01/2020
-
HLA-B*1502 Variant Analysis for Carbamazepine Response
Effective 07/01/2020
-
HLA-B*5701 Genotyping for Abacavir Hypersensitivity
Effective 07/01/2020
-
Huntington Disease Testing
Effective 07/01/2020
-
Hypertrophic Cardiomyopathy Testing
Effective 07/01/2020
-
Immunohistochemistry (IHC)
Effective 07/01/2020
-
KRAS Testing for Anti-EGFR Response in Metastatic Colorectal Cancer
Effective 07/01/2020
-
Laboratory Claim Reimbursement
Effective 07/01/2020
-
Legius Syndrome Genetic Testing
Effective 07/01/2020
-
Leber Hereditary Optic Neuropathy (LHON) Genetic Testing
Effective 07/01/2020
-
Li-Fraumeni Syndrome Testing
Effective 07/01/2020
-
Liquid Biopsy Testing - Solid Tumors
Effective 07/01/2020
-
Long QT Syndrome Testing
Effective 07/01/2020
-
Lynch Syndrome Genetic Testing
Effective 07/01/2020
-
Lynch Syndrome Tumor Screening - First-Tier
Effective 07/01/2020
-
Lynch Syndrome Tumor Screening - Second-Tier
Effective 07/01/2020
-
Macula Risk
Effective 07/01/2020
-
Mammaprint 70-Gene Breast Cancer Recurrence Assay
Effective 07/01/2020
-
Mammostrat Breast Cancer Recurrence Assay
Effective 07/01/2020
-
Marfan Syndrome Genetic Testing
Effective 07/01/2020
-
Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS) Genetic Testing
Effective 07/01/2020
-
Multiple Endocrine Neoplasia Type 1 (MEN1)
Effective 07/01/2020
-
Multiple Endocrine Neoplasia Type 2 (MEN2)
Effective 07/01/2020
-
Myoclonic Epilepsy with Ragged Red Fibers (MERRF)
Effective 07/01/2020
-
MGMT Testing for Malignant Glioma Alkylating Agent Response
Effective 07/01/2020
-
Mitochondrial DNA Deletion Syndromes
Effective 07/01/2020
-
Mitochondrial Genetic Testing
Effective 07/01/2020
-
Mitochondrial Neurogastrointestinal Encephalopathy (MNGIE)
Effective 07/01/2020
-
Maturity-Onset Diabetes of the Young (MODY) Testing
Effective 07/01/2020
-
MTHFR Variant Analysis for Hyperhomocysteinemia
Effective 07/01/2020
-
MUTYH Associated Polyposis Testing
Effective 07/01/2020
-
myChoice CDx
Effective 07/01/2020
-
Myotonic Dystrophy Type 1 Genetic Testing
Effective 07/01/2020
-
myRisk Hereditary Cancer Testing
Effective 07/01/2020
-
Neurogenic Muscle Weakness, Ataxia, and Retinitis Pigmentosa (NARP)
Effective 07/01/2020
-
NETest
Effective 07/01/2020
-
Neurofibromatosis Type 1 Genetic Testing
Effective 07/01/2020
-
Niemann-Pick Disease Types A and B Testing
Effective 07/01/2020
-
Niemann-Pick Type C Testing
Effective 07/01/2020
-
Non-Invasive Prenatal Screening
Effective 07/01/2020
-
OncotypeDX Breast DCIS
Effective 07/01/2020
-
OncotypeDX for Breast Cancer Prognosis
Effective 07/01/2020
-
OncotypeDX for Colorectal Cancer Recurrence Risk
Effective 07/01/2020
-
OncotypeDX for Prostate Cancer
Effective 07/01/2020
-
OVA1
Effective 07/01/2020
-
PALB2 Genetic Testing for Breast Cancer Risk
Effective 07/01/2020
-
PancraGEN
Effective 07/01/2020
-
PCA3 Testing for Prostate Cancer
Effective 07/01/2020
-
Peutz-Jeghers Syndrome Testing
Effective 07/01/2020
-
Polymerase Gamma (POLG) Related Disorders Genetic Testing
Effective 07/01/2020
-
Prader-Willi Syndrome Testing
Effective 07/01/2020
-
Prenatal Aneuploidy FISH Testing
Effective 07/01/2020
-
Prenatal Maternal Serum Screening
Effective 07/01/2020
-
Prolaris
Effective 07/01/2020
-
ProMark Proteomic Prognostic Test
Effective 07/01/2020
-
Prosigna Breast Cancer Prognostic Gene Signature Assay
Effective 07/01/2020
-
PTEN Hamartoma Tumor Syndromes Testing
Effective 07/01/2020
-
Rett Syndrome Testing
Effective 07/01/2020
-
Molecular Respiratory Infection Pathogen Panel (RIPP) Testing
Effective 10/01/2020
-
SelectMDx
Effective 07/01/2020
-
SensiGene Fetal RHD Genotyping
Effective 07/01/2020
-
Sept9 Methylation Analysis for Colorectal Cancer
Effective 07/01/2020
-
Somatic Mutation Testing - Hematological Malignancies
Effective 07/01/2020
-
Somatic Mutation Testing - Solid Tumors
Effective 10/01/2020
-
Spinal Muscular Atrophy Testing
Effective 07/01/2020
-
Spinocerebellar Ataxia Genetic Testing
Effective 07/01/2020
-
Thoracic Aortic Aneurysms and Dissections (TAAD) Panel Testing
Effective 07/01/2020
-
Tay Sachs Disease Testing
Effective 07/01/2020
-
ThyGeNEXT and ThyraMIR miRNA Gene Expression Classifier
Effective 07/01/2020
-
Thyroseq
Effective 07/01/2020
-
Tissue of Origin Testing for Cancer of Unknown Primary
Effective 07/01/2020
-
TPMT Testing for Thiopurine Drug Response
Effective 07/01/2020
-
UGT1A1 Mutation Analysis for Irinotecan Response
Effective 07/01/2020
-
UroVysion FISH for Bladder Cancer
Effective 07/01/2020
-
VeriStrat Testing for NSCLC TKI Response
Effective 07/01/2020
-
Von Hippel-Lindau Disease Testing
Effective 07/01/2020
-
Whole Genome Sequencing
Effective 10/01/2020