-
Date of Service and Effective Date of the Authorization Period
Effective 01/01/2021
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Medical Necessity Review Information Requirements
Effective 01/01/2021
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Molecular Pathology Tier 2 Molecular CPT Codes
Effective 01/01/2021
-
Unique Test Identifiers for Non-Specific Procedure Codes
Effective 01/01/2021
-
Confirmatory Genetic Testing
Effective 01/01/2021
-
Genetic Presymptomatic and Predictive Testing for Adult-Onset Conditions in Minors
Effective 01/01/2021
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Genetic Testing by Multigene Panels
Effective 01/01/2021
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Genetic Testing for Cancer Susceptibility and Hereditary Cancer Syndromes
Effective 01/01/2021
-
Genetic Testing for Carrier Status
Effective 01/01/2021
-
Genetic Testing for Known Familial Mutations
Effective 01/01/2021
-
Genetic Testing for Non-Medical Purposes
Effective 01/01/2021
-
Genetic Testing for Prenatal Screening and Diagnostic Testing
Effective 01/01/2021
-
Genetic Testing for the Screening, Diagnosis, and Monitoring of Cancer
Effective 01/01/2021
-
Genetic Testing for Variants of Uncertain Clinical Significance
Effective 01/01/2021
-
Genetic Testing to Diagnose Non-Cancer Conditions
Effective 01/01/2021
-
Genetic Testing to Predict Disease Risk
Effective 01/01/2021
-
Hereditary (Germline) Testing After Tumor (Somatic) Testing
Effective 01/01/2021
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Investigational and Experimental Molecular and Genomic Testing
Effective 01/01/2021
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Pharmacogenomic Testing for Drug Toxicity and Response
Effective 01/01/2021
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Preimplantation Genetic Screening and Diagnosis
Effective 01/01/2021
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4Kscore for Prostate Cancer Risk Assessment
Effective 01/01/2021
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ABL Tyrosine Kinase Sequencing for Chronic Myeloid Leukemia
Effective 01/01/2021
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Afirma Thyroid Cancer Classifier Tests
Effective 01/01/2021
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AlloMap Gene Expression Profiling For Heart Transplant Rejection
Effective 01/01/2021
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AlloSure for Kidney Transplant Rejection
Effective 01/01/2021
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Alpha-1-Antitrypsin Deficiency Testing
Effective 01/01/2021
-
Amyotrophic Lateral Sclerosis (ALS) Genetic Testing
Effective 01/01/2021
-
Acute Myeloid Leukemia (AML) Genetic Testing
Effective 01/01/2021
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Angelman Syndrome Testing
Effective 01/01/2021
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Anser Testing
Effective 01/01/2021
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APOE Variant Analysis for Alzheimer Disease
Effective 01/01/2021
-
Ashkenazi Jewish Carrier Screening
Effective 01/01/2021
-
Ataxia-Telangiectasia Testing
Effective 01/01/2021
-
BCR-ABL Negative Myeloproliferative Neoplasm Testing
Effective 01/01/2021
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BCR-ABL Testing for Chronic Myeloid Leukemia
Effective 01/01/2021
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Bloom Syndrome Testing
Effective 01/01/2021
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BRCA Analysis
Effective 01/01/2021
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BRCA Ashkenazi Jewish Founder Mutation Testing
Effective 01/01/2021
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Breast Cancer Index for Breast Cancer Prognosis
Effective 01/01/2021
-
Brugada Syndrome Genetic Testing
Effective 01/01/2021
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CADASIL Testing
Effective 01/01/2021
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Canavan Disease Testing
Effective 01/01/2021
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CellSearch Circulating Tumor Cell Count for Breast Cancer Prognosis
Effective 01/01/2021
-
Charcot-Marie-Tooth Neuropathy Testing
Effective 01/01/2021
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CHARGE Syndrome Genetic Testing
Effective 01/01/2021
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Chromosome Analysis for Blood and Bone Marrow
Effective 01/01/2021
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Chromosome Analysis for Reproductive Disorders, Prenatal Testing, and Developmental Disorders
Effective 01/01/2021
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Chromosomal Microarray for Prenatal Diagnosis
Effective 01/01/2021
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Chromosomal Microarray for Solid Tumors
Effective 01/01/2021
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Chromosomal Microarray Testing For Developmental Disorders
Effective 01/01/2021
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Cologuard Screening for Colorectal Cancer
Effective 01/01/2021
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ConfirmMDx for Prostate Cancer Risk Assessment
Effective 01/01/2021
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Cxbladder
Effective 01/01/2021
-
Cystic Fibrosis Testing
Effective 01/01/2021
-
Decipher Prostate Cancer Classifier
Effective 01/01/2021
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DecisionDx Uveal Melanoma
Effective 01/01/2021
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Dentatorubral Pallidoluysian Atrophy Testing
Effective 01/01/2021
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DermTech Pigmented Lesion Assay
Effective 01/01/2021
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Duchenne and Becker Muscular Dystrophy Testing
Effective 01/01/2021
-
Ehlers-Danlos Syndrome Testing
Effective 01/01/2021
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EndoPredict for Breast Cancer Prognosis
Effective 01/01/2021
-
Early Onset Familial Alzheimer Disease (EOFAD) Genetic Testing
Effective 01/01/2021
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Exome Sequencing
Effective 01/01/2021
-
Expanded Carrier Screening Panels
Effective 01/01/2021
-
Factor II/Prothrombin Testing for Thrombophilia
Effective 01/01/2021
-
Factor V Leiden Testing for Thrombophilia_Eff01012021
Effective 01/01/2021
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Familial Adenomatous Polyposis Testing
Effective 01/01/2021
-
Familial Hypercholesterolemia Genetic Testing
Effective 01/01/2021
-
Familial Malignant Melanoma Testing
Effective 01/01/2021
-
FibroTest/FibroSURE
Effective 01/01/2021
-
Flow Cytometry
Effective 01/01/2021
-
FMR1-Related Disorders (Fragile X) Genetic Testing
Effective 01/01/2021
-
Friedreich's Ataxia Genetic Testing
Effective 01/01/2021
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Gaucher Disease Testing
Effective 01/01/2021
-
GeneSight Psychotropic Test
Effective 01/01/2021
-
Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy
Effective 01/01/2021
-
Genetic Testing for Autism, Intellectual Disability, and Developmental Delay
Effective 01/01/2021
-
Genetic Testing for Dilated Cardiomyopathy
Effective 01/01/2021
-
Genetic Testing for Epilepsy
Effective 01/01/2021
-
Genetic Testing for Facioscapulohumeral Muscular Dystrophy
Effective 01/01/2021
-
Genetic Testing for Hereditary Pancreatitis
Effective 01/01/2021
-
Genetic Testing for Limb Girdle Muscular Dystrophy
Effective 01/01/2021
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Genetic Testing for Nonsyndromic Hearing Loss and Deafness
Effective 01/01/2021
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Genitourinary Conditions: Molecular Testing
Effective 01/01/2021
-
Molecular Gastrointestinal Pathogen Panel (GIPP) Testing
Effective 01/01/2021
-
GPS Cancer (NantHealth)
Effective 01/01/2021
-
Hemoglobinopathies Genetic Testing
Effective 01/01/2021
-
Hereditary Ataxia Multigene Panel Testing
Effective 01/01/2021
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Hereditary Cancer Syndrome Multigene Panels
Effective 01/01/2021
-
Hereditary Connective Tissue Disorder Testing
Effective 01/01/2021
-
Hereditary Hemochromatosis Testing
Effective 01/01/2021
-
HIV Tropism Testing for Maraviroc Response
Effective 01/01/2021
-
HLA Typing for Celiac Disease
Effective 01/01/2021
-
Huntington Disease Testing
Effective 01/01/2021
-
Hypertrophic Cardiomyopathy Testing
Effective 01/01/2021
-
Immunohistochemistry (IHC)
Effective 01/01/2021
-
In-vitro testing for HIV
Effective 01/01/2021
-
In-vitro testing for SARS-CoV-2 (COVID-19)
Effective 01/01/2021
-
Laboratory Claim Reimbursement
Effective 01/01/2021
-
Legius Syndrome Genetic Testing
Effective 01/01/2021
-
Li-Fraumeni Syndrome Testing
Effective 01/01/2021
-
Liquid Biopsy Testing - Solid Tumors
Effective 01/01/2021
-
Long QT Syndrome Testing
Effective 01/01/2021
-
Lyme Disease Testing
Effective 01/01/2021
-
Lynch Syndrome Genetic Testing
Effective 01/01/2021
-
Lynch Syndrome Tumor Screening - Second-Tier
Effective 01/01/2021
-
Macula Risk
Effective 01/01/2021
-
Mammaprint 70-Gene Breast Cancer Recurrence Assay
Effective 01/01/2021
-
Mammostrat Breast Cancer Recurrence Assay
Effective 01/01/2021
-
Marfan Syndrome Genetic Testing
Effective 01/01/2021
-
Medically Necessary Laboratory Testing
Effective 01/01/2021
-
Multiple Endocrine Neoplasia Type 1 (MEN1)
Effective 01/01/2021
-
Multiple Endocrine Neoplasia Type 2 (MEN2)
Effective 01/01/2021
-
MGMT Testing for Malignant Glioma Alkylating Agent Response
Effective 01/01/2021
-
Microsatellite Instability and Immunohistochemistry Testing in Cancer
Effective 01/01/2021
-
Mitochondrial Genetic Testing
Effective 01/01/2021
-
Maturity-Onset Diabetes of the Young (MODY) Testing
Effective 01/01/2021
-
MTHFR Variant Analysis for Hyperhomocysteinemia
Effective 01/01/2021
-
MUTYH Associated Polyposis Testing
Effective 01/01/2021
-
myChoice CDx
Effective 01/01/2021
-
Myotonic Dystrophy Type 1 Genetic Testing
Effective 01/01/2021
-
NETest
Effective 01/01/2021
-
Neurofibromatosis Type 1 Genetic Testing
Effective 01/01/2021
-
Niemann-Pick Disease Types A and B Testing
Effective 01/01/2021
-
Niemann-Pick Type C Testing
Effective 01/01/2021
-
Non-Invasive Prenatal Screening
Effective 01/01/2021
-
OncotypeDX Breast DCIS
Effective 01/01/2021
-
OncotypeDX for Breast Cancer Prognosis
Effective 01/01/2021
-
OncotypeDX for Colorectal Cancer Recurrence Risk
Effective 01/01/2021
-
OncotypeDX for Prostate Cancer
Effective 01/01/2021
-
OVA1
Effective 01/01/2021
-
PALB2 Genetic Testing for Breast Cancer Risk
Effective 01/01/2021
-
PancraGEN
Effective 01/01/2021
-
PCA3 Testing for Prostate Cancer
Effective 01/01/2021
-
Polymerase Gamma (POLG) Related Disorders Genetic Testing
Effective 01/01/2021
-
Prader-Willi Syndrome Testing
Effective 01/01/2021
-
Prenatal Aneuploidy FISH Testing
Effective 01/01/2021
-
Prenatal Maternal Serum Screening
Effective 01/01/2021
-
Prolaris
Effective 01/01/2021
-
ProMark Proteomic Prognostic Test
Effective 01/01/2021
-
Prosigna Breast Cancer Prognostic Gene Signature Assay
Effective 01/01/2021
-
PTEN Hamartoma Tumor Syndromes Testing
Effective 01/01/2021
-
Rett Syndrome Testing
Effective 01/01/2021
-
Molecular Respiratory Infection Pathogen Panel (RIPP) Testing
Effective 01/01/2021
-
SelectMDx
Effective 01/01/2021
-
Sept9 Methylation Analysis for Colorectal Cancer
Effective 01/01/2021
-
Somatic Mutation Testing - Hematological Malignancies
Effective 01/01/2021
-
Somatic Mutation Testing - Solid Tumors
Effective 01/01/2021
-
Spinal Muscular Atrophy Testing
Effective 01/01/2021
-
Spinocerebellar Ataxia Genetic Testing
Effective 01/01/2021
-
Thoracic Aortic Aneurysms and Dissections (TAAD) Panel Testing
Effective 01/01/2021
-
Tay Sachs Disease Testing
Effective 01/01/2021
-
ThyGeNEXT and ThyraMIR miRNA Gene Expression Classifier
Effective 01/01/2021
-
Thyroseq
Effective 01/01/2021
-
Tissue of Origin Testing for Cancer of Unknown Primary
Effective 01/01/2021
-
UroVysion FISH for Bladder Cancer
Effective 01/01/2021
-
VeriStrat Testing for NSCLC TKI Response
Effective 01/01/2021
-
Von Hippel-Lindau Disease Testing
Effective 01/01/2021
-
Whole Genome Sequencing
Effective 01/01/2021