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Molecular and Genomic Testing Program

Horizon collaborates with eviCore healthcare (eviCore) to conduct pre- and post-service Medical Necessity Determination (MND) reviews of certain molecular and genomic diagnostic testing services that are rendered in a physician’s office or clinical laboratory setting.

This program applies to Horizon members in fully-insured products and Administrative Services Only (ASO) accounts that participate in the Molecular and Genomic Testing Program.

Review the list of tests that are subject to MND review as part of this program.

Policies

Access the molecular and genomic diagnostic laboratory testing guidelines that apply to members enrolled in plans that participate in Molecular and Genomic Testing Program.

The eviCore guidelines were developed using evidence-based guidelines and incorporate criteria derived from published materials that are supported by nationally-recognized agencies.

Resources

Molecular and Genomic Testing Procedure Code Listing

Medical Information Requirements

eviCore Online Forms & Resources