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Genetic Testing Policies


Patrius Health partners with Carelon Medical Benefits Management, an independent company, to administer advanced imaging solutions for our customers.

Note: Coverage is subject to the member's specific benefits. Group-specific policies will supersede these policies when applicable. Please refer to the member's benefit plan.

Draft Genetic Testing Policies

 

As part of the Carelon guideline annual review process, the below updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable healthcare services.

Effective for dates of service on and after November 17, 2024, the changes in the document below will apply to the Carelon Medical Benefits Management Genetic Testing Clinical Appropriateness Guidelines.

Summary of Changes to Carelon Genetic Testing Clinical Appropriateness Guidelines Effective November 17, 2024

Draft Imaging Policies

Clicking "Accept" will take you to a website operated by Carelon Medical Benefits Management. 


 

Comment on Draft Policies

To ensure that the development of medical policies occurs through an open, collaborative process, we welcome comments about medical policies that are in the draft stage. 

Participating providers are invited to submit scientific, evidence-based information, professional consensus opinions and other information supported by medical literature relevant to these draft policies for consideration. 

Comments are accepted for 45 days from the posting date listed on the draft policy.

Make sure your voice is heard by providing feedback directly to us:

Patrius Health
Attn: Health Management - Medical Policy
P.O. Box 12364
Birmingham, AL 35202-2364

Fax: 205-220-0878

Precertification of Genetic Testing Services

Some genetic testing services require precertification. Click the link below to view a list of applicable CPT/HCPCS codes.

Genetic Testing Codes Requiring Precertification