Policy details

WellFirst Health updated medical policies for Genetic Testing in June 2017, and continues to update policies biannually on an ongoing basis. As genetic testing has increasingly become the standard of care, WellFirst Health is committed to the access and quality of these services for our members. Our current genetic testing policies were developed by our contracted vendor Concert Genetics, an industry leader in genetic testing technology assessment and policy development.

Here are a few things to consider:

  • General Approach to Genetic Testing Medical Policy MP9610, describes the general approach for any genetic testing not specifically addressed in another policy. It also serves as the general policy for genetic testing and will provide links to specific genetic tests.
  • Genetic tests must meet applicable evidenced based guidelines and be medically necessary. 
  • Genetic counseling and medical necessity requirements may be test specific, as identified within each medical policy.
  • Medical necessity criteria will be applied to Commercial HMO, POS, PPO, and ASO members. WellFirst Health Medicare Advantage does not have genetic testing authorization requirements.
  • ASO members are excluded from any Genetic Counseling requirements.
  • For laboratories only — Every genetic test is assigned a genetic testing unit (GTU), a unique alphanumeric identifier for payers who utilize Concert Genetic services. This unique GTU may be found on the Concert Genetic Platform. Every genetic test has been assigned a GTU. Log in at concertgenetics.com to find the GTU for your requested genetic test.
For services that require authorization, submit prior authoization requests via the WellFirst Health provider portal

View a list of genetic tests that require prior authorization.

Providers without portal access may fax the genetic testing prior authorization form to the number indicated on the form. 
Certain tests require pre-test and post- test genetic counseling. Prior authorization is not required for referrals to a genetic counselor.

See our full list of genetic testing policies. 

Additional resources