Genetic molecular lab testing preauthorization program
Capital offers an innovative genetic molecular lab testing preauthorization program designed to guide the best possible care for our members while balancing cost to best serve our customers.
Our genetic molecular lab testing preauthorization program is supported by a team of doctors who can provide an expert-level review for evidence-based care for specific tests (listed below). More specialized preauthorization reviews can mean better outcomes, reduced costs, and safer procedures. Here’s how:
- Better safety and quality for your employees.
- Appropriate evidence-based treatment plan management and interventions.
- Enhanced network support.
- Reduced care costs.
- Care based on patient’s health history and diagnosis.
What tests are covered?
The following genetic molecular lab tests are covered for outpatient services (inpatient services do not require preauthorization):
- Hereditary cancer syndromes.
- Carrier screening tests.
- Tumor marker / molecular profiling.
- Immunohistochemistry (IHC).
- Hereditary cardiac disorders.
- Cardiovascular disease and thrombosis risk variant testing.
- Pharmacogenomics testing.
- Neurologic disorders.
- Mitochondrial disease testing.
- Intellectual disability / developmental disorders.
Medical policies
Visit eviCore healthcare for more information about these medical policies.
Contact your Capital Blue Cross account executive with any questions.
Capital Blue Cross contracts with eviCore healthcare (eviCore) to review requests for certain services for medical necessity and appropriateness on behalf of capital Blue Cross members.