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Update: Molecular and Genomic Testing Program for March 2019

In addition to recently announced changes to our Molecular and Genomic Testing Program, eviCore will also conduct pre-service Medical Necessity Determination (MND) reviews of procedure code 0081U (a new Proprietary Laboratory Analyses code for 2019) when rendered in a physician’s office or clinical laboratory¹ on and after March 1, 2019.

Review a revised list of molecular and genomic diagnostic testing services that require pre-service MND reviews.

Visit our Molecular and Genomic Testing Program web page for more information about this specialty utilization management program. If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

¹ MND requirements will 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.


PRE-SERVICE MND REVIEWS

To obtain pre-service MND from eviCore (or to validate that a pre-service MND was requested and/or approved):

  • Visit.eviCore.com; or
  • Call 1-844-224-0493, between 7 a.m. and 7 p.m., Eastern Time.

Review the guidelines eviCore uses to conduct MND reviews as part of the Molecular and Genomic Testing Program.

Published on: December 26, 2018, 11:17 a.m. ET
Last updated on: October 10, 2019, 03:28 a.m. ET