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Molecular and Genomic Testing Program Update

Effective May 7, 2018, additional services will be included as part of our Molecular and Genomic Testing Program, administered by eviCore healthcare (eviCore) for members enrolled in Horizon BCBSNJ fully-insured products as well as administrative services only (ASO) accounts that have elected the Molecular and Genomic Testing Program.

Beginning with services to be provided on and after May 7, 2018, eviCore will conduct pre-service Medical Necessity Determination (MND) reviews of the following diagnostic testing services (recently published by the American Medical Association) when rendered in a physician's office or clinical laboratory:1

  • 0036U
  • 0037U

Review the complete list of molecular and genomic diagnostic testing services that require pre-service MND review.

For more information about this specialty utilization management program, please visit our Molecular and Genomic Testing Program web page.

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

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

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


Pre-service MND reviews
Please visit.eviCore.com or call 1-844-224-0493 between 7 a.m. and 7 p.m., Eastern Time, to obtain pre-service MND from eviCore or to validate that a pre-service MND was requested and/or approved.

The guidelines eviCore uses to conduct MND reviews for the Molecular and Genomic Testing Program may be reviewed online at www.evicore.com/healthplan/Horizon_Lab.

Published on: April 5, 2018, 12:51 p.m. ET
Last updated on: April 5, 2018, 14:52 p.m. ET