Take Action Before Ordering Genetic Tests. See Details on the Genetic Testing Prior Authorization Program

Posted on 2019-02-04
Updated on 2019-02-04 09:00:00

Genetic Test Prior Authorization Launched — Action is Required of Ordering Providers

As a reminder, effective Feb.1, 2019, the genetic testing prior authorization program was launched. Ordering providers and their staff will need to obtain a prior authorization for molecular genetic testing – the new requirement is for the following categories of covered genetic tests for effective dates of service on or after Feb. 1, 2019:

  • Reproductive Carrier Screening
  • Prenatal Testing
  • Rare Disease Testing
  • Whole Exome Sequencing
  • Genome Sequencing
  • Hereditary Cancer Testing
  • Tumor Markers categorized as genetic tests
  • Hereditary Cardiac Testing
  • Neurogenetic and Neuromuscular Testing
  • Pharmacogenomics and Thrombophilia Testing
  • Susceptibility Testing for Common Disease

This program will help our members receive evidence-based genetic test(s) while helping providers select the appropriate testing. Additionally, the program is intended to lower the cost of genetic testing while helping to ensure members receive all appropriate testing. You may find some of the following information helpful:

To request a prior authorization for genetic tests, log on to the CareFirst Provider Portal and navigate to the Prior Auth/Notifications tab to begin your request. Look for the Add New Auth dropdown in the upper right-hand corner.