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Molecular and Genomic Testing Program Update: December 2021

Horizon will add service codes to our Molecular and Genomic Testing Program, administered by eviCore healthcare (eviCore). Members enrolled in Horizon fully-insured products as well as administrative services only (ASO) accounts participate in the Molecular and Genomic Testing Program.

For services to be rendered on and after December 4, 2021 in a physician’s office or clinical laboratory, eviCore will also conduct pre-service Medical Necessity Determination (MND) reviews of the services represented by the following, recently added Proprietary Laboratory Analyses (PLA) codes:

0258U
0260U
0262U
0264U
0265U
0266U
0267U
0268U
0269U
0270U
0271U
0272U
0273U
0274U
0276U
0277U
0278U
0282U
G0327

Review the complete list of molecular and genomic diagnostic testing services subject to MND review as part of this program or review more details about our Molecular and Genomic Testing Program.

If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

eviCore healthcare is an independent company that supports Horizon in the provision of Medical Necessity Determination reviews of certain molecular and genomic diagnostic testing services that are rendered in a physician’s office or clinical laboratory setting.

MND requirements do not apply to molecular and genomic diagnostic testing services rendered to patients in a hospital Emergency Room, hospital outpatient or inpatient setting or an Ambulatory Surgery Center (ASC).

CPT® is a registered trademark of the American Medical Association.

Published on: November 3, 2021, 22:19 p.m. ET
Last updated on: November 2, 2021, 06:33 a.m. ET