Laboratory Management
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We based this decision on the guideline as listed below:
-MTHFR Variant Analysis for Hyperhomocysteinemia (MOL.TX.205).
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Code Lists
Guidelines
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MOL.AD.107.A Unique Test Identifiers for Non-Specific Procedure Codes
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MOL.AD.304.A Medical Necessity Review Information Requirements
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MOL.AD.314.A Date of Service and Authorization Period Effective Date
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MOL.AD.364.A Special Circumstances Influencing Coverage Determinations
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MOL.AD.391.A Laboratory Procedure Code Requirements
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MOL.CU.109.A Genetic Testing for Cancer Susceptibility and Hereditary Cancer Syndromes
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MOL.CU.110.A Genetic Testing for Carrier Status
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MOL.CU.111.A Genetic Testing for Non-Medical Purposes
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MOL.CU.112.A Genetic Testing for Prenatal Screening and Diagnostic Testing
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MOL.CU.113.A Genetic Testing for the Screening, Diagnosis, and Monitoring of Cancer
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MOL.CU.114.A Genetic Testing to Diagnose Non-Cancer Conditions
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MOL.CU.115.A Genetic Testing to Predict Disease Risk
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MOL.CU.116.A Genetic Testing by Multigene Panels
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MOL.CU.117.A Experimental, Investigational or Unproven Laboratory Testing
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MOL.CU.118.A Pharmacogenomic Testing for Drug Toxicity and Response
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MOL.CU.119.A Preimplantation Genetic Screening and Diagnosis
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MOL.CU.246.A Hereditary (Germline) Testing After Tumor (Somatic) Testing
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MOL.CU.256.A Confirmatory Genetic Testing
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MOL.CU.291.A Genetic Testing for Known Familial Mutations
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MOL.CU.292.A Genetic Testing for Variants of Uncertain Clinical Significance
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MOL.CU.298.A Genetic Presymptomatic and Predictive Testing for Adult-Onset Conditions in Minors
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MOL.CU.333.B Medically Necessary Laboratory Testing
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MOL.TS.120.B 4Kscore for Prostate Cancer Risk Assessment
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MOL.TS.122.A Afirma Thyroid Cancer Classifier Tests
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MOL.TS.123.A AlloMap Gene Expression Profiling For Heart Transplant Rejection
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MOL.TS.124.A Alpha-1 Antitrypsin Deficiency Testing
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MOL.TS.125.A Amyotrophic Lateral Sclerosis (ALS) Genetic Testing
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MOL.TS.126.A Angelman Syndrome Genetic Testing
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MOL.TS.128.A APOE Variant Analysis for Alzheimer Disease Testing
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MOL.TS.129.A Ashkenazi Jewish Carrier Screening
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MOL.TS.130.A Ataxia-Telangiectasia Genetic Testing
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MOL.TS.132.A Bloom Syndrome Genetic Testing
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MOL.TS.144.A CADASIL Genetic Testing
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MOL.TS.145.A Canavan Disease Genetic Testing
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MOL.TS.148.A Charcot-Marie-Tooth Neuropathy Genetic Testing
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MOL.TS.150.A Chromosomal Microarray Testing For Developmental Disorders (Prenatal and Postnatal)
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MOL.TS.151.A Chromosome Analysis for Blood and Bone Marrow Cancers
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MOL.TS.153.A ConfirmMDx for Prostate Cancer Risk Assessment
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MOL.TS.158.A Cystic Fibrosis Genetic Testing
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MOL.TS.159.A Dentatorubral-Pallidoluysian Atrophy Genetic Testing
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MOL.TS.161.A Duchenne and Becker Muscular Dystrophy Testing
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MOL.TS.162.A Early Onset Familial Alzheimer Disease Genetic Testing
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MOL.TS.164.A SEPT9 Methylation Analysis for Colorectal Cancer
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MOL.TS.165.A Expanded Carrier Screening Panels
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MOL.TS.168.A Familial Adenomatous Polyposis Genetic Testing
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MOL.TS.169.A Familial Hypercholesterolemia Genetic Testing
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MOL.TS.170.A Familial Malignant Melanoma Genetic Testing
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MOL.TS.172.A FMR1-Related Disorders (Fragile X) Genetic Testing
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MOL.TS.173.A Gaucher Disease Genetic Testing
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MOL.TS.182.A Hereditary Cancer Syndrome Multigene Panels
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MOL.TS.183.A HFE Hemochromatosis Genetic Testing
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MOL.TS.188.A Huntington Disease Genetic Testing
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MOL.TS.193.A Li-Fraumeni Syndrome Genetic Testing
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MOL.TS.194.A Liquid Biopsy Testing
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MOL.TS.197.A Lynch Syndrome Genetic Testing
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MOL.TS.199.A Lynch Syndrome Tumor Screening - Second-Tier
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MOL.TS.200.A Mammaprint 70-Gene Breast Cancer Recurrence Assay
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MOL.TS.202.A Marfan Syndrome Genetic Testing
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MOL.TS.206.A MUTYH Associated Polyposis Genetic Testing
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MOL.TS.207.A Niemann-Pick Disease Types A and B GeneticTesting
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MOL.TS.208.A Niemann-Pick Disease Type C Genetic Testing
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MOL.TS.209.A Non-Invasive Prenatal Screening
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MOL.TS.211.A Oncotype DX for Breast Cancer Prognosis
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MOL.TS.213.A Oncotype DX for Colorectal Cancer Recurrence Risk
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MOL.TS.216.A: Peutz-Jeghers Syndrome Genetic Testing
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MOL.TS.217.A: Prader-Willi Syndrome Genetic Testing
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MOL.TS.220.A: Prenatal Maternal Serum Screening
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MOL.TS.222.N: Prosigna Breast Cancer Prognostic Gene Signature Assay
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MOL.TS.223.A: PTEN Hamartoma Tumor Syndromes Genetic Testing
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MOL.TS.224.A: Rett Syndrome Genetic Testing
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MOL.TS.225.A: Spinal Muscular Atrophy Genetic Testing
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MOL.TS.226.A: Tay-Sachs Disease Genetic Testing
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MOL.TS.227.A: Thoracic Aortic Aneurysms and Dissections (TAAD) Panel Genetic Testing
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MOL.TS.228.A: Tissue of Origin Testing for Cancer of Unknown Primary
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MOL.TS.230.A Somatic Mutation Testing
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MOL.TS.232.A: VeriStrat Testing for NSCLC TKI Response
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MOL.TS.233.A: Von Hippel-Lindau Disease Genetic Testing
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MOL.TS.234.A: EndoPredict for Breast Cancer Prognosis
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MOL.TS.235.A: Exome Sequencing
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MOL.TS.236.A: Cxbladder
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MOL.TS.238.A: BRCA Analysis
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MOL.TS.240.A: BCR-ABL Negative Myeloproliferative Neoplasm Testing
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MOL.TS.248.A: Breast Cancer Index for Breast Cancer Prognosis
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MOL.TS.250.A: NETest
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MOL.TS.251.A: PALB2 Genetic Testing for Breast Cancer Risk
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MOL.TS.254.A: DecisionDX Uveal Melanoma
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MOL.TS.255.A: Oncotype DX Breast DCIS
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MOL.TS.257.A: Epilepsy Genetic Testing
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MOL.TS.258.A: Maturity-Onset Diabetes of the Young (MODY) Genetic Testing
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MOL.TS.259.A: ThyGeNEXT and ThyraMIR miRNA Gene Expression Classifier
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MOL.TS.260.A: OVA1
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MOL.TS.264.A: SelectMDx
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MOL.TS.266.A: Mitochondrial Disorders Genetic Testing
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MOL.TS.267.A: Ehlers-Danlos Syndrome Genetic Testing
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MOL.TS.268.A: Hereditary Connective Tissue Disorder Genetic Testing
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MOL.TS.269.A: Autism, Intellectual Disability, and Developmental Delay Genetic Testing
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MOL.TS.270.A: Thyroseq
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MOL.TS.271.A: PancraGEN
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MOL.TS.273.A: Nonsyndromic Hearing Loss and Deafness Genetic Testing
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MOL.TS.276.A: Polymerase Gamma (POLG) Related Disorders Genetic Testing
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MOL.TS.282.A: DermTech Pigmented Lesion Assay
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MOL.TS.285.A: Multiple Endocrine Neoplasia Type 1 Genetic Testing
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MOL.TS.286.A: Multiple Endocrine Neoplasia Type 2 Genetic Testing
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MOL.TS.287.A: Hereditary Pancreatitis Genetic Testing
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MOL.TS.288.A: Limb-Girdle Muscular Dystrophy Genetic Testing
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MOL.TS.290.A: Facioscapulohumeral Muscular Dystrophy Genetic Testing
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MOL.TS.294.A: Decipher Prostate Cancer Classifier
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MOL.TS.295.A: Genomic Prostate Score
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MOL.TS.297.A: Prolaris
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MOL.TS.301.A: Neurofibromatosis Type 1 Genetic Testing
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MOL.TS.302.A: Legius Syndrome Genetic Testing
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MOL.TS.306.A: Genome Sequencing
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MOL.TS.307.A: AlloSure for Kidney Transplant Rejection
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MOL.TS.308.A: Hemoglobinopathies Genetic Testing
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MOL.TS.309.A: Friedreich Ataxia Genetic Testing
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MOL.TS.310.A: Hereditary Ataxia Multigene Panel Testing
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MOL.TS.311.A: Spinocerebellar Ataxia Genetic Testing
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MOL.TS.312.A: Myotonic Dystrophy Type 1 Genetic Testing
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MOL.TS.324.A: CHARGE Syndrome and CHD7 Disorder Genetic Testing (previously CHARGE Syndrome Genetic Testing)
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MOL.TS.344.A: Chromosomal Microarray for Solid Tumors
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MOL.TS.356.A: Microsatellite Instability and Immunohistochemistry Testing in Cancer
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MOL.TS.360.A: Inherited Bone Marrow Failure Syndrome (IBMFS) Testing
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MOL.TS.361.A: Human Platelet and Red Blood Cell Antigen Genotyping
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MOL.TS.370.A: Inherited Thrombophilia Genetic Testing
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MOL.TS.371.A: Noonan Spectrum Disorder Genetic Testing
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MOL.TS.396.A: Multi-Cancer Early Detection Screening
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MOL.TS.401.A: Liver Fibrosis Assessment Biomarkers
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MOL.TS.410.A: Cardiomyopathy and Arrhythmia Genetic Testing
Guidelines
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MOL.AD.107.A Unique Test Identifiers for Non-Specific Procedure CodesEffective 01/01/2025 - 06/30/2025
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MOL.AD.304.A Medical Necessity Review Information RequirementsEffective 01/01/2025 - 06/30/2025
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MOL.AD.314.A Date of Service and Authorization Period Effective DateEffective 01/01/2025 - 06/30/2025
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MOL.AD.364.A Special Circumstances Influencing Coverage DeterminationsEffective 01/01/2025 - 06/30/2025
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MOL.AD.412.A Laboratory Billing and ReimbursementEffective 01/01/2025 - 06/30/2025
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MOL.AD.101.A Medicare: Hierarchy for Applying Coverage Decisions for Laboratory TestingEffective 01/01/2025 - 06/30/2025
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MOL.AD.355.AL Medicaid: Hierarchy for Applying Coverage Decisions for Laboratory Testing for AllWays Health Partners Managed Medicaid Members in the State of MassachusettsEffective 01/01/2025 - 06/30/2025
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MOL.CU.109.A Genetic Testing for Cancer Susceptibility and Hereditary Cancer SyndromesEffective 01/01/2025 - 06/30/2025
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MOL.CU.110.A Genetic Testing for Carrier StatusEffective 01/01/2025 - 06/30/2025
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MOL.CU.111.A Genetic Testing for Non-Medical PurposesEffective 01/01/2025 - 06/30/2025
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MOL.CU.112.A Genetic Testing for Prenatal Screening and Diagnostic TestingEffective 01/01/2025 - 06/30/2025
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MOL.CU.113.A Genetic Testing for the Screening, Diagnosis, and Monitoring of CancerEffective 01/01/2025 - 06/30/2025
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MOL.CU.114.A Genetic Testing to Diagnose Non-Cancer ConditionsEffective 01/01/2025 - 06/30/2025
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MOL.CU.115.A Genetic Testing to Predict Disease RiskEffective 01/01/2025 - 06/30/2025
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MOL.CU.116.A Genetic Testing by Multigene PanelsEffective 01/01/2025 - 06/30/2025
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MOL.CU.117.A Experimental, Investigational, or Unproven Laboratory TestingEffective 01/01/2025 - 06/30/2025
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MOL.CU.118.A Pharmacogenomic Testing for Drug Toxicity and ResponseEffective 01/01/2025 - 06/30/2025
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MOL.CU.119.A Preimplantation Genetic Screening and DiagnosisEffective 01/01/2025 - 06/30/2025
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MOL.CU.246.A Hereditary (Germline) Testing After Tumor (Somatic) TestingEffective 01/01/2025 - 06/30/2025
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MOL.CU.256.A Confirmatory Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.CU.291.A Genetic Testing for Known Familial MutationsEffective 01/01/2025 - 06/30/2025
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MOL.CU.292.A Genetic Testing for Variants of Uncertain Clinical SignificanceEffective 01/01/2025 - 06/30/2025
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MOL.CU.333.B Medically Necessary Laboratory TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.120.B 4Kscore for Prostate Cancer Risk AssessmentEffective 01/01/2025 - 06/30/2025
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MOL.TS.122.A Afirma Thyroid Cancer Classifier TestsEffective 01/01/2025 - 06/30/2025
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MOL.TS.123.A AlloMap Gene Expression Profiling For Heart Transplant RejectionEffective 01/01/2025 - 06/30/2025
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MOL.TS.124.A Alpha-1 Antitrypsin Deficiency TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.125.A Amyotrophic Lateral Sclerosis (ALS) Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.126.A Angelman Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.128.A APOE Variant Analysis for Alzheimer Disease TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.129.A Ashkenazi Jewish Carrier ScreeningEffective 01/01/2025 - 06/30/2025
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MOL.TS.130.A Ataxia-Telangiectasia Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.144.A CADASIL Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.148.A Charcot-Marie-Tooth Neuropathy Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.150.A Chromosomal Microarray Testing For Developmental Disorders (Prenatal and Postnatal)Effective 01/01/2025 - 06/30/2025
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MOL.TS.151.A Chromosome Analysis for Blood and Bone Marrow CancersEffective 01/01/2025 - 06/30/2025
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MOL.TS.153.A ConfirmMDx for Prostate Cancer Risk AssessmentEffective 01/01/2025 - 06/30/2025
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MOL.TS.158.A Cystic Fibrosis Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.159.A Dentatorubral-Pallidoluysian Atrophy Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.161.A Duchenne and Becker Muscular Dystrophy TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.162.A Early Onset Familial Alzheimer Disease Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.164.A SEPT9 Methylation Analysis for Colorectal CancerEffective 01/01/2025 - 06/30/2025
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MOL.TS.165.A Carrier Screening Panels, Including Targeted, Pan-Ethnic, Universal, and ExpandedEffective 01/01/2025 - 06/30/2025
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MOL.TS.168.A Familial Adenomatous Polyposis Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.169.A Familial Hypercholesterolemia Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.170.A Familial Malignant Melanoma Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.172.A FMR1-Related Disorders (Fragile X) Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.182.A Hereditary Cancer Syndrome Multigene PanelsEffective 01/01/2025 - 06/30/2025
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MOL.TS.183.A HFE Hemochromatosis Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.188.A Huntington Disease Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.193.A Li-Fraumeni Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.194.A Liquid Biopsy TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.197.A Lynch Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.199.A Lynch Syndrome Tumor Screening - Second-TierEffective 01/01/2025 - 06/30/2025
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MOL.TS.200.A Mammaprint 70-Gene Breast Cancer Recurrence AssayEffective 01/01/2025 - 06/30/2025
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MOL.TS.202.A Marfan Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.206.A MUTYH Associated Polyposis Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.209.A Non-Invasive Prenatal ScreeningEffective 01/01/2025 - 06/30/2025
-
MOL.TS.211.A Oncotype DX for Breast Cancer PrognosisEffective 01/01/2025 - 06/30/2025
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MOL.TS.213.A Oncotype DX for Colorectal Cancer Recurrence RiskEffective 01/01/2025 - 06/30/2025
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MOL.TS.215.A PCA3 Testing for Prostate CancerEffective 01/01/2025 - 06/30/2025
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MOL.TS.216.A Peutz-Jeghers Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.217.A Prader-Willi Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.220.A Prenatal Maternal Serum ScreeningEffective 01/01/2025 - 06/30/2025
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MOL.TS.222.N: Prosigna Breast Cancer Prognostic Gene Signature AssayEffective 01/01/2025 - 06/30/2025
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MOL.TS.223.A: PTEN Hamartoma Tumor Syndromes Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.224.A: Rett Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.225.A: Spinal Muscular Atrophy Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.227.A: Thoracic Aortic Aneurysms and Dissections (TAAD) Panel Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.228.A: Tissue of Origin Testing for Cancer of Unknown PrimaryEffective 01/01/2025 - 06/30/2025
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MOL.TS.230.A: Somatic Mutation TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.232.A: VeriStrat Testing for NSCLC TKI ResponseEffective 01/01/2025 - 06/30/2025
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MOL.TS.233.A: Von Hippel-Lindau Disease Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.234.A: EndoPredict for Breast Cancer PrognosisEffective 01/01/2025 - 06/30/2025
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MOL.TS.235.A: Exome SequencingEffective 01/01/2025 - 06/30/2025
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MOL.TS.236.A: CxbladderEffective 01/01/2025 - 06/30/2025
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MOL.TS.238.A: BRCA AnalysisEffective 01/01/2025 - 06/30/2025
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MOL.TS.240.A: BCR-ABL Negative Myeloproliferative Neoplasm Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.248.A: Breast Cancer Index for Breast Cancer PrognosisEffective 01/01/2025 - 06/30/2025
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MOL.TS.250.A: NETestEffective 01/01/2025 - 06/30/2025
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MOL.TS.251.A: PALB2 Genetic Testing for Cancer RiskEffective 01/01/2025 - 06/30/2025
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MOL.TS.254.A DecisionDX Uveal MelanomaEffective 01/01/2025 - 06/30/2025
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MOL.TS.255.A Oncotype DX Breast DCISEffective 01/01/2025 - 06/30/2025
-
MOL.TS.257.A Epilepsy Genetic TestingEffective 01/01/2025 - 06/30/2025
-
MOL.TS.258.A Maturity-Onset Diabetes of the Young Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.259.A ThyGeNEXT and ThyraMIR miRNA Gene Expression ClassifiEffective 01/01/2025 - 06/30/2025
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MOL.TS.260.A OVA1Effective 01/01/2025 - 06/30/2025
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MOL.TS.264.A SelectMDxEffective 01/01/2025 - 06/30/2025
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MOL.TS.266.A Mitochondrial Disorders Genetic TestingEffective 01/01/2025 - 06/30/2025
-
MOL.TS.267.A Ehlers-Danlos Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.268.A: Hereditary Connective Tissue Disorder Genetic TestingEffective 01/01/2025 - 06/30/2025
-
MOL.TS.269.A Autism, Intellectual Disability, and Developmental Delay Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.270.A ThyroseqEffective 01/01/2025 - 06/30/2025
-
MOL.TS.271.A PancraGENEffective 01/01/2025 - 06/30/2025
-
MOL.TS.273.A: Nonsyndromic Hearing Loss and Deafness Genetic TestingEffective 01/01/2025 - 06/30/2025
-
MOL.TS.276.A Polymerase Gamma (POLG) Related Disorders Genetic TestingEffective 01/01/2025 - 06/30/2025
-
MOL.TS.282.A: DermTech Pigmented Lesion AssayEffective 01/01/2025 - 06/30/2025
-
MOL.TS.285.A: Multiple Endocrine Neoplasia Type 1 Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.286.A: Multiple Endocrine Neoplasia Type 2 Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.287.A: Hereditary Pancreatitis Genetic TestingEffective 01/01/2025 - 06/30/2025
-
MOL.TS.288.A Limb-Girdle Muscular Dystrophy Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.290.A: Facioscapulohumeral Muscular Dystrophy Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.294.A Decipher Prostate Cancer ClassifierEffective 01/01/2025 - 06/30/2025
-
MOL.TS.295.A Genomic Prostate ScoreEffective 01/01/2025 - 06/30/2025
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MOL.TS.297.A ProlarisEffective 01/01/2025 - 06/30/2025
-
MOL.TS.301.A Neurofibromatosis Type 1 Genetic TestingEffective 01/01/2025 - 06/30/2025
-
MOL.TS.302.A Legius Syndrome Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.306.A Genome SequencingEffective 01/01/2025 - 06/30/2025
-
MOL.TS.307.A AlloSure for Kidney Transplant RejectionEffective 01/01/2025 - 06/30/2025
-
MOL.TS.308.A Hemoglobinopathies Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.309.A Friedreich Ataxia Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.310.A Hereditary Ataxia Multigene Panel Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.311.A Spinocerebellar Ataxia Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.312.A Myotonic Dystrophy Type 1 Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.324.A: CHARGE Syndrome and CHD7 Disorder Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.344.A Chromosomal Microarray for Solid TumorsEffective 01/01/2025 - 06/30/2025
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MOL.TS.356.A Microsatellite Instability and Immunohistochemistry Testing in CancerEffective 01/01/2025 - 06/30/2025
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MOL.TS.359.A Inflammatory Bowel Disease Biomarker TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.360.A Inherited Bone Marrow Failure Syndrome (IBMFS) TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.361.A Human Platelet and Red Blood Cell Antigen GenotypingEffective 01/01/2025 - 06/30/2025
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MOL.TS.370.A Inherited Thrombophilia Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.371.A Noonan Spectrum Disorder Genetic TestinEffective 01/01/2025 - 06/30/2025
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MOL.TS.396.A Multi-Cancer Early Detection ScreeningEffective 01/01/2025 - 06/30/2025
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MOL.TS.401.A Liver Fibrosis Assessment BiomarkersEffective 01/01/2025 - 06/30/2025
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MOL.TS.410.A Cardiomyopathy and Arrhythmia Genetic TestingEffective 01/01/2025 - 06/30/2025
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MOL.TS.413.A: ColoSense for Colorectal CancerEffective 01/01/2025 - 06/30/2025
Code Lists
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Lab Management Code ListEffective 10/01/2023 - 12/31/2023
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Lab Management Code ListEffective 07/01/2023 - 09/30/2023
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Lab Management Code ListEffective 04/01/2023 - 06/30/2023
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Lab Prior Authorization CPT Code ListEffective 04/01/2024 - 06/30/2024
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Lab Prior Authorization CPT Code ListEffective 07/01/2024 - 09/30/2024
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Lab Prior Authorization CPT Code ListEffective 01/01/2024 - 03/31/2024
Guidelines
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AllWays Health Partners Lab Management GuidelinesEffective 01/01/2020 - 06/30/2020
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AllWays Health Partners Lab Management GuidelinesEffective 07/01/2021 - 12/31/2021
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AllWays Health Partners Lab Management GuidelinesEffective 01/01/2022 - 06/30/2022
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AllWays Health Partners Lab Management GuidelinesEffective 07/03/2017 - 01/01/2018
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AllWays Health Partners Lab Management GuidelinesEffective 07/02/2018 - 01/01/2019
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AllWays Health Partners Lab Management GuidelinesEffective 07/01/2019 - 12/31/2019
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AllWays Health Partners Lab Management GuidelinesEffective 01/02/2018 - 07/01/2018
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AllWays Health Partners Lab Management GuidelinesEffective 07/01/2022 - 12/31/2022
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AllWays Health Partners Lab Management GuidelinesEffective 01/02/2019 - 06/30/2019
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AllWays Health Partners Lab Management GuidelinesEffective 07/01/2020 - 12/31/2020
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AllWays Health Partners Lab Management GuidelinesEffective 01/01/2021 - 06/30/2021
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Mass General Brigham Health Lab Management GuidelinesEffective 01/01/2024 - 06/30/2024
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Mass General Brigham Health Plan Lab Management GuidelinesEffective 01/01/2023 - 06/30/2023
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Mass General Brigham Health Plan Lab Management GuidelinesEffective 07/01/2023 - 12/31/2023
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MOL.AD.107.A: Unique Test Identifiers for Non Specific Procedure CodesEffective 07/01/2023 - 12/31/2023
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MOL.AD.107.A: Unique Test Identifiers for Non-Specific Procedure CodesEffective 01/01/2024 - 06/30/2024
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MOL.AD.304.A: Medical Necessity Review Information RequirementsEffective 01/01/2024 - 06/30/2024
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MOL.AD.304.A: Medical Necessity Review Information RequirementsEffective 07/01/2023 - 12/31/2023
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MOL.AD.314.A: Date of Service and Authorization Period Effective DateEffective 07/01/2023 - 12/31/2023
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MOL.AD.314.A: Date of Service and Authorization Period Effective DateEffective 01/01/2024 - 06/30/2024
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MOL.AD.364.A: Special Circumstances Influencing Coverage DeterminationsEffective 01/01/2024 - 06/30/2024
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MOL.AD.364.A: Special Circumstances Influencing Coverage DeterminationsEffective 07/01/2023 - 12/31/2023
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MOL.AD.391.A: Laboratory Procedure Code RequirementsEffective 07/01/2023 - 12/31/2023
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MOL.AD.391.A: Laboratory Procedure Code RequirementsEffective 01/01/2024 - 06/30/2024
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MOL.AD.101.A: Medicare Hierarchy for Applying Coverage Decision for Laboratory TestingEffective 02/01/2023 - 12/31/2023
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MOL.AD.101.A: Medicare: Hierarchy for Applying Coverage Decisions for Laboratory TestingEffective 01/01/2024 - 06/30/2024
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MOL.AD.355.AL: Medicaid Hierarchy Applying Coverage Decisions Lab Testing AllWaysEffective 07/01/2023 - 12/31/2023
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MOL.AD.355.AL: Medicaid: Hierarchy for Applying Coverage Decisions for Laboratory Testing for AllWays Health Partners Managed Medicaid Members in the State of MassachusettsEffective 01/01/2024 - 06/30/2024
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MOL.CU.109.A: Genetic Testing for Cancer Susceptibility and Hereditary Cancer SyndromesEffective 01/01/2024 - 06/30/2024
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MOL.CU.109.A: Genetic Testing for Cancer Susceptibility and Hereditary Cancer SyndromesEffective 07/01/2023 - 12/31/2023
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MOL.CU.110.A: Genetic Testing for Carrier StatusEffective 07/01/2023 - 12/31/2023
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MOL.CU.110.A: Genetic Testing for Carrier StatusEffective 01/01/2024 - 06/30/2024
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MOL.CU.111.A: Genetic Testing for Non Medical PurposesEffective 07/01/2023 - 12/31/2023
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MOL.CU.111.A: Genetic Testing for Non-Medical PurposesEffective 01/01/2024 - 06/30/2024
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MOL.CU.112.A: Genetic Testing for Prenatal Screening and Diagnostic TestingEffective 01/01/2024 - 06/30/2024
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MOL.CU.112.A: Genetic Testing for Prenatal Screening and Diagnostic TestingEffective 07/01/2023 - 12/31/2023
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MOL.CU.113.A: Genetic Testing for the Screening, Diagnosis, and Monitoring of CancerEffective 01/01/2024 - 06/30/2024
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MOL.CU.113.A: Genetic Testing for the Screening, Diagnosis, and Monitoring of CancerEffective 07/01/2023 - 12/31/2023
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MOL.CU.114.A: Genetic Testing to Diagnose Non Cancer ConditionsEffective 07/01/2023 - 12/31/2023
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MOL.CU.114.A: Genetic Testing to Diagnose Non-Cancer ConditionsEffective 01/01/2024 - 06/30/2024
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MOL.CU.115.A: Genetic Testing to Predict Disease RiskEffective 01/01/2024 - 06/30/2024
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MOL.CU.115.A: Genetic Testing to Predict Disease RiskEffective 07/01/2023 - 12/31/2023
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MOL.CU.116.A: Genetic Testing by Multigene PanelsEffective 01/01/2024 - 06/30/2024
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MOL.CU.116.A: Genetic Testing by Multigene PanelsEffective 07/01/2023 - 12/31/2023
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MOL.CU.117.A Investigational Experimental General Laboratory TestingEffective 07/01/2023 - 12/31/2023
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MOL.CU.117.A: Investigational and Experimental Laboratory TestingEffective 01/01/2024 - 06/30/2024
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MOL.CU.118.A Pharmacogenomic Testing for Drug Toxicity and ResponseEffective 07/01/2023 - 12/31/2023
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MOL.CU.118.A: Pharmacogenomic Testing for Drug Toxicity and ResponseEffective 01/01/2024 - 06/30/2024
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MOL.CU.119.A: Preimplantation Genetic Screening and DiagnosisEffective 01/01/2024 - 06/30/2024
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MOL.CU.119.A: Preimplantation Genetic Screening and DiagnosisEffective 07/01/2023 - 12/31/2023
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MOL.CU.246.A: Hereditary (Germline) Testing After Tumor (Somatic) TestingEffective 07/01/2023 - 12/31/2023
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MOL.CU.246.A: Hereditary (Germline) Testing After Tumor (Somatic) TestingEffective 01/01/2024 - 06/30/2024
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MOL.CU.256.A: Confirmatory Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.CU.256.A: Confirmatory Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.CU.291.A: Genetic Testing for Known Familial MutationsEffective 01/01/2024 - 06/30/2024
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MOL.CU.291.A: Genetic Testing for Known Familial MutationsEffective 07/01/2023 - 12/31/2023
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MOL.CU.292.A: Genetic Testing for Variants of Uncertain Clinical SignificanceEffective 07/01/2023 - 12/31/2023
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MOL.CU.292.A: Genetic Testing for Variants of Uncertain Clinical SignificanceEffective 01/01/2024 - 06/30/2024
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MOL.CU.298.A: Genetic Presymptomatic and Predictive Testing for Adult Onset Conditions in MinorsEffective 07/01/2023 - 12/31/2023
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MOL.CU.298.A: Genetic Presymptomatic and Predictive Testing for Adult-Onset Conditions in MinorsEffective 01/01/2024 - 06/30/2024
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MOL.CU.333.B: Medically Necessary Laboratory TestingEffective 07/01/2023 - 12/31/2023
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MOL.CU.333.B: Medically Necessary Laboratory TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.120.B: 4Kscore for Prostate Cancer Risk AssessmentEffective 07/01/2023 - 12/31/2023
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MOL.TS.120.B: 4Kscore for Prostate Cancer Risk AssessmentEffective 01/01/2024 - 06/30/2024
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MOL.TS.122.A: Afirma Thyroid Cancer Classifier TestsEffective 01/01/2024 - 06/30/2024
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MOL.TS.122.A: Afirma Thyroid Cancer Classifier TestsEffective 07/01/2023 - 12/31/2023
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MOL.TS.123.A AlloMap Gene Expression Profiling For Heart Transplant RejectionEffective 01/01/2024 - 06/30/2024
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MOL.TS.123.A: AlloMap Gene Expression Profiling for Heart Transplant RejectionEffective 07/01/2023 - 12/31/2023
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MOL.TS.124.A: Alpha 1 Antitrypsin Deficiency TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.124.A: Alpha-1 Antitrypsin Deficiency TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.125.A: Amyotrophic Lateral Sclerosis (ALS) Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.125.A: Amyotrophic Lateral Sclerosis (ALS) Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.126.A: Angelman Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.126.A: Angelman Syndrome TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.128.A: APOE Variant Analysis for Alzheimer Disease TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.128.A: APOE Variant Analysis for Alzheimer Disease TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.129.A: Ashkenazi Jewish Carrier ScreeningEffective 01/01/2024 - 06/30/2024
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MOL.TS.129.A: Ashkenazi Jewish Carrier ScreeningEffective 07/01/2023 - 12/31/2023
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MOL.TS.130.A: Ataxia Telangiectasia TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.130.A: Ataxia-Telangiectasia Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.132.A: Bloom Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.132.A: Bloom Syndrome TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.135.A: BRCA Ashkenazi Jewish Founder Mutation TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.144.A: CADASIL Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.144.A: CADASIL TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.145.A: Canavan Disease Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.145.A: Canavan Disease TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.148.A: Charcot-Marie-Tooth Neuropathy TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.148.A: Charcot-Marie-Tooth Neuropathy TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.149.A: Chromosomal Microarray for Prenatal DiagnosisEffective 01/01/2024 - 06/30/2024
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MOL.TS.149.A: Chromosomal Microarray for Prenatal DiagnosisEffective 07/01/2023 - 12/31/2023
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MOL.TS.150.A: Chromosomal Microarray Testing For Developmental DisordersEffective 01/01/2024 - 06/30/2024
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MOL.TS.150.A: Chromosomal Microarray Testing For Developmental DisordersEffective 07/01/2023 - 12/31/2023
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MOL.TS.151.A: Chromosome Analysis for Blood and Bone Marrow CancersEffective 07/01/2023 - 12/31/2023
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MOL.TS.151.A: Chromosome Analysis for Blood and Bone Marrow CancersEffective 01/01/2024 - 06/30/2024
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MOL.TS.153.A: ConfirmMDx for Prostate Cancer Risk AssessmentEffective 07/01/2023 - 12/31/2023
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MOL.TS.153.A: ConfirmMDx for Prostate Cancer Risk AssessmentEffective 01/01/2024 - 06/30/2024
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MOL.TS.158.A: Cystic Fibrosis Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.158.A: Cystic Fibrosis TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.159.A: Dentatorubral Pallidoluysian Atrophy TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.159.A: Dentatorubral-Pallidoluysian Atrophy Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.161.A: Duchenne and Becker Muscular Dystrophy TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.161.A: Duchenne and Becker Muscular Dystrophy TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.162.A: Early Onset Familial Alzheimer Disease Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.162A: Early Onset Familial Alzheimer Disease (EOFAD) Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.164.A: SEPT9 Methylation Analysis for Colorectal CancerEffective 07/01/2023 - 12/31/2023
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MOL.TS.164.A: SEPT9 Methylation Analysis for Colorectal CancerEffective 01/01/2024 - 06/30/2024
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MOL.TS.165.A Expanded Carrier Screening PanelsEffective 07/01/2023 - 12/31/2023
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MOL.TS.165.A: Expanded Carrier Screening PanelsEffective 01/01/2024 - 06/30/2024
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MOL.TS.168.A: Familial Adenomatous PolyposisEffective 07/01/2023 - 12/31/2023
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MOL.TS.168.A: Familial Adenomatous Polyposis Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.169.A: Familial Hypercholesterolemia Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.169.A: Familial Hypercholesterolemia Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.170.A: Familial Malignant Melanoma Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.170.A: Familial Malignant Melanoma TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.172.A: FMR1 Related Disorders (Fragile X) Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.172.A: FMR1-Related Disorders (Fragile X) Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.173.A: Gaucher Disease Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.173.A: Gaucher Disease TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.182.A: Hereditary Cancer Syndrome Multigene PanelsEffective 07/01/2023 - 12/31/2023
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MOL.TS.182.A: Hereditary Cancer Syndrome Multigene PanelsEffective 01/01/2024 - 06/30/2024
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MOL.TS.183.A: Hemochromatosis TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.183.A: HFE Hemochromatosis Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.188.A: Huntington DiseaseEffective 07/01/2023 - 12/31/2023
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MOL.TS.188.A: Huntington Disease Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.189.A- Hypertrophic Cardiomyopathy Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.189.A: Hypertrophic Cardiomyopathy TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.193.A: Li Fraumeni SyndromeEffective 07/01/2023 - 12/31/2023
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MOL.TS.193.A: Li-Fraumeni Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.194.A Liquid Biopsy TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.194.A: Liquid Biopsy TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.196.A: Long QT Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.196.A: Long QT Syndrome TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.197.A: Lynch Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.197.A: Lynch Syndrome Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.199.A: Lynch Syndrome Tumor Screening - Second TierEffective 07/01/2023 - 12/31/2023
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MOL.TS.199.A: Lynch Syndrome Tumor Screening - Second-TierEffective 01/01/2024 - 06/30/2024
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MOL.TS.200.A: Mammaprint 70-Gene Breast Cancer Recurrence AssayEffective 01/01/2024 - 06/30/2024
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MOL.TS.200.A: Mammaprint 70-Gene Breast Cancer Recurrence AssayEffective 07/01/2023 - 12/31/2023
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MOL.TS.202.A: Marfan Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.202.A: Marfan Syndrome Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.206.A: MUTYH Associated Polyposis TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.206.A: MUTYH-Associated Polyposis Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.207.A: Niemann-Pick Disease Types A and B Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.207.A: Niemann-Pick Disease Types A and B TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.208 A: Niemann-Pick Type C TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.208.A: Niemann-Pick Disease Type C Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.209.A: Non-Invasive Prenatal ScreeningEffective 01/01/2024 - 06/30/2024
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MOL.TS.209.A: Non-Invasive Prenatal ScreeningEffective 07/01/2023 - 12/31/2023
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MOL.TS.211.A: Oncotype DX for Breast Cancer PrognosisEffective 07/01/2023 - 12/31/2023
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MOL.TS.211.A: Oncotype DX for Breast Cancer PrognosisEffective 01/01/2024 - 06/30/2024
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MOL.TS.213.A: Oncotype DX for Colorectal Cancer Recurrence RiskEffective 07/01/2023 - 12/31/2023
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MOL.TS.213.A: Oncotype DX for Colorectal Cancer Recurrence RiskEffective 01/01/2024 - 06/30/2024
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MOL.TS.215.A: PCA3 Testing for Prostate CancerEffective 01/01/2024 - 06/30/2024
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MOL.TS.215.A: PCA3 Testing for Prostate CancerEffective 07/01/2024 - 08/31/2024
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MOL.TS.215.A: PCA3 Testing for Prostate CancerEffective 07/01/2023 - 12/31/2023
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MOL.TS.216.A: Peutz-Jeghers Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.216.A: Peutz-Jeghers Syndrome TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.217.A: Prader-Willi Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.217.A: Prader-Willi Syndrome TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.220.A: Prenatal Maternal Serum ScreeningEffective 01/01/2024 - 06/30/2024
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MOL.TS.220.A: Prenatal Maternal Serum ScreeningEffective 07/01/2023 - 12/31/2023
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MOL.TS.222.N: Prosigna Breast Cancer Prognostic Gene Signature AssayEffective 07/01/2023 - 12/31/2023
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MOL.TS.222.N: Prosigna Breast Cancer Prognostic Gene Signature AssayEffective 01/01/2024 - 06/30/2024
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MOL.TS.223.A: PTEN Hamartoma Tumor Syndromes Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.223.A: PTEN Hamartoma Tumor Syndromes TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.224.A: Rett Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.224.A: Rett Syndrome TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.225.A: Spinal Muscular Atrophy Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.225.A: Spinal Muscular Atrophy TestingEffective 01/01/2022 - 06/30/2022
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MOL.TS.225.A: Spinal Muscular Atrophy TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.226.A: Tay Sachs Disease TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.226.A: Tay-Sachs Disease Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.227.A: Thoracic Aortic Aneurysms and Dissections (TAAD) Panel Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.227.A: Thoracic Aortic Aneurysms and Dissections TAAD Panel TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.228.A: Tissue of Origin Testing for Cancer of Unknown PrimaryEffective 07/01/2023 - 12/31/2023
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MOL.TS.228.A: Tissue of Origin Testing for Cancer of Unknown PrimaryEffective 01/01/2024 - 06/30/2024
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MOL.TS.230.A: Somatic Mutation Testing-Solid TumorsEffective 01/01/2024 - 06/30/2024
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MOL.TS.230.A: Somatic Mutation Testing-Solid TumorsEffective 07/01/2023 - 12/31/2023
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MOL.TS.232.A: VeriStrat Testing for NSCLC TKI ResponseEffective 07/01/2023 - 12/31/2023
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MOL.TS.232.A: VeriStrat Testing for NSCLC TKI ResponseEffective 01/01/2024 - 06/30/2024
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MOL.TS.233.A: Von Hippel Lindau Disease TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.233.A: Von Hippel-Lindau Disease Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.234.A: EndoPredict for Breast Cancer PrognosisEffective 07/01/2023 - 12/31/2023
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MOL.TS.234.A: EndoPredict for Breast Cancer PrognosisEffective 01/01/2024 - 06/30/2024
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MOL.TS.235.A: Exome SequencingEffective 01/01/2024 - 06/30/2024
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MOL.TS.235.A: Exome SequencingEffective 07/01/2023 - 12/31/2023
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MOL.TS.236.A: CxbladderEffective 07/01/2023 - 12/31/2023
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MOL.TS.236.A: CxbladderEffective 01/01/2024 - 06/30/2024
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MOL.TS.238.A: BRCA AnalysisEffective 07/01/2023 - 12/31/2023
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MOL.TS.238.A: BRCA AnalysisEffective 01/01/2024 - 06/30/2024
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MOL.TS.240.A: BCR ABL Negative Myeloproliferative Neoplasm TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.240.A: BCR-ABL Negative Myeloproliferative Neoplasm Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.248.A: Breast Cancer Index for Breast Cancer PrognosisEffective 07/01/2023 - 12/31/2023
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MOL.TS.248.A: Breast Cancer Index for Breast Cancer PrognosisEffective 01/01/2024 - 06/30/2024
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MOL.TS.250.A: NETestEffective 07/01/2023 - 12/31/2023
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MOL.TS.250.A: NETestEffective 01/01/2024 - 06/30/2024
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MOL.TS.251.A: PALB2 Genetic Testing for Breast Cancer RiskEffective 01/01/2024 - 06/30/2024
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MOL.TS.251.A: PALB2 Genetic Testing for Breast Cancer RiskEffective 07/01/2023 - 12/31/2023
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MOL.TS.254.A: DecisionDX Uveal MelanomaEffective 01/01/2024 - 06/30/2024
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MOL.TS.254.A: DecisionDx Uveal MelanomaEffective 07/01/2023 - 12/31/2023
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MOL.TS.255.A: Oncotype DX Breast DCISEffective 07/01/2023 - 12/31/2023
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MOL.TS.255.A: Oncotype DX Breast DCISEffective 01/01/2024 - 06/30/2024
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MOL.TS.257.A: Epilepsy Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.257.A: Genetic Testing for EpilepsyEffective 07/01/2023 - 12/31/2023
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MOL.TS.258.A: Maturity Onset Diabetes of the Young (MODY) TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.258.A: Maturity-Onset Diabetes of the Young (MODY) Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.259.A: ThyGeNEXT and ThyraMIR miRNA Gene Expression ClassifierEffective 07/01/2023 - 12/31/2023
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MOL.TS.259.A: ThyGeNEXT and ThyraMIR miRNA Gene Expression ClassifierEffective 01/01/2024 - 06/30/2024
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MOL.TS.260.A: OVA1Effective 07/01/2023 - 12/31/2023
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MOL.TS.260.A: OVA1Effective 01/01/2024 - 06/30/2024
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MOL.TS.261.A: Brugada Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.261.A: Brugada Syndrome Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.262.A: FibroTest FibroSUREEffective 07/01/2023 - 12/31/2023
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MOL.TS.264.A: SelectMDxEffective 01/01/2024 - 06/30/2024
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MOL.TS.264.A: SelectMDxEffective 07/01/2023 - 12/31/2023
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MOL.TS.266.A: Mitochondrial Disorders Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.266.A: Mitochondrial Disorders Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.267.A: Ehlers Danlos Syndrome TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.267.A: Ehlers-Danlos Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.268.A: Hereditary Connective Tissue Disorder Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.268.A: Hereditary Connective Tissue Disorder TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.269.A: Autism, Intellectual Disability, and Developmental Delay Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.269.A: Genetic Testing for Autism, Intellectual Disability, and Developmental DelayEffective 07/01/2023 - 12/31/2023
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MOL.TS.270.A: ThyroSeqEffective 07/01/2023 - 12/31/2023
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MOL.TS.270.A: ThyroseqEffective 01/01/2024 - 06/30/2024
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MOL.TS.271.A: PancraGENEffective 01/01/2024 - 06/30/2024
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MOL.TS.271.A: PancraGENEffective 07/01/2023 - 12/31/2023
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MOL.TS.273.A: Genetic Testing for Nonsyndromic Hearing Loss and DeafnessEffective 07/01/2023 - 12/31/2023
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MOL.TS.273.A: Nonsyndromic Hearing Loss and Deafness Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.276.A: Polymerase Gamma (POLG) Related Disorders Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.276.A: Polymerase Gamma (POLG) Related Disorders Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.281.A: Arrhythmogenic Right Ventricular Cardiomyopathy Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.281.A: Genetic Testing for Arrhythmogenic Right Ventricular CardiomyopathyEffective 07/01/2023 - 12/31/2023
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MOL.TS.282.A: DermTech Pigmented Lesion AssayEffective 07/01/2023 - 12/31/2023
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MOL.TS.282.A: DermTech Pigmented Lesion AssayEffective 01/01/2024 - 06/30/2024
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MOL.TS.284.A: Dilated Cardiomyopathy Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.284.A: Genetic Testing for Dilated CardiomyopathyEffective 07/01/2023 - 12/31/2023
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MOL.TS.285.A: Multiple Endocrine Neoplasia Type 1 (MEN1)Effective 07/01/2023 - 12/31/2023
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MOL.TS.285.A: Multiple Endocrine Neoplasia Type 1 Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.286.A: Multiple Endocrine Neoplasia Type 2 (MEN2)Effective 07/01/2023 - 12/31/2023
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MOL.TS.286.A: Multiple Endocrine Neoplasia Type 2 Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.287.A: Genetic Testing for Hereditary PancreatitisEffective 07/01/2023 - 12/31/2023
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MOL.TS.287.A: Hereditary Pancreatitis Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.288.A: Genetic Testing for Limb Girdle Muscular DystrophyEffective 07/01/2023 - 12/31/2023
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MOL.TS.288.A: Limb-Girdle Muscular Dystrophy Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.290.A: Facioscapulohumeral Muscular Dystrophy Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.290.A: Genetic Testing for Facioscapulohumeral Muscular DystrophyEffective 07/01/2023 - 12/31/2023
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MOL.TS.294.A: Decipher Prostate Cancer ClassifierEffective 07/01/2023 - 12/31/2023
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MOL.TS.294.A: Decipher Prostate Cancer ClassifierEffective 01/01/2024 - 06/30/2024
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MOL.TS.295.A: Genomic Prostate ScoreEffective 01/01/2024 - 06/30/2024
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MOL.TS.295.A: Oncotype DX for Prostate CancerEffective 07/01/2023 - 12/31/2023
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MOL.TS.297.A: ProlarisEffective 07/01/2023 - 12/31/2023
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MOL.TS.297.A: ProlarisEffective 01/01/2024 - 06/30/2024
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MOL.TS.300.A: Macula RiskEffective 07/01/2023 - 12/31/2023
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MOL.TS.301.A: Neurofibromatosis Type 1 Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.301.A: Neurofibromatosis Type 1 Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.302.A: Legius Syndrome Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.302.A: Legius Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.306.A: Whole Genome SequencingEffective 07/01/2023 - 12/31/2023
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MOL.TS.306.A: Whole Genome SequencingEffective 01/01/2024 - 06/30/2024
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MOL.TS.307.A: AlloSure for Kidney Transplant RejectionEffective 07/01/2023 - 12/31/2023
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MOL.TS.307.A: AlloSure for Kidney Transplant RejectionEffective 01/01/2024 - 06/30/2024
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MOL.TS.308.A: Hemoglobinopathies Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.308.A: Hemoglobinopathies Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.309.A: Friedreich Ataxia Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.309.A: Friedreich Ataxia Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.310.A: Hereditary Ataxia Multigene Panel Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.310.A: Hereditary Ataxia Multigene Panel TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.311.A: Spinocerebellar Ataxia Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.311.A: Spinocerebellar Ataxia Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.312.A: Myotonic Dystrophy Type 1 Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.312.A: Myotonic Dystrophy Type 1 Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.313.A: Somatic Mutation Testing Hematological MalignanciesEffective 01/01/2024 - 06/30/2024
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MOL.TS.313.A: Somatic Mutation Testing Hematological MalignanciesEffective 07/01/2023 - 12/31/2023
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MOL.TS.324.A: CHARGE Syndrome Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.324.A: CHARGE Syndrome Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.340.A: GeneSight Psychotropic TestEffective 01/01/2024 - 06/30/2024
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MOL.TS.340.A: GeneSight Psychotropic TestEffective 07/01/2023 - 12/31/2023
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MOL.TS.344.A: Chromosomal Microarray for Solid TumorsEffective 07/01/2023 - 12/31/2023
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MOL.TS.344.A: Chromosomal Microarray for Solid TumorsEffective 01/01/2024 - 06/30/2024
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MOL.TS.356.A: Microsatellite Instability and Immunohistochemistry Testing in CancerEffective 01/01/2024 - 06/30/2024
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MOL.TS.356.A: Microsatellite Instability and Immunohistochemistry Testing in CancerEffective 07/01/2023 - 12/31/2023
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MOL.TS.360.A: Inherited Bone Marrow Failure Syndrome (IBMFS) TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.360.A: Inherited Bone Marrow Failure Syndrome (IBMFS) TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.361.A: Human Platelet and Red Blood Cell Antigen GenotypingEffective 07/01/2023 - 12/31/2023
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MOL.TS.361.A: Human Platelet and Red Blood Cell Antigen GenotypingEffective 01/01/2024 - 06/30/2024
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MOL.TS.370.A: Inherited Thrombophilia Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.370.A: Inherited Thrombophilia Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.371.A: Noonan Spectrum Disorder Genetic TestingEffective 01/01/2024 - 06/30/2024
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MOL.TS.371.A: Noonan Spectrum Disorder Genetic TestingEffective 07/01/2023 - 12/31/2023
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MOL.TS.396.A: Multi-Cancer Early Detection ScreeningEffective 07/01/2023 - 12/31/2023
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MOL.TS.396.A: Multi-Cancer Early Detection ScreeningEffective 01/01/2024 - 06/30/2024
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MOL.TS.401.A: Liver Fibrosis Assessment BiomarkersEffective 01/01/2024 - 06/30/2024