Molecular and Genetic Testing Billing Requirements

Genetic testing involves molecular analysis of human DNA, RNA, genes, and chromosomes to detect whether or not a person has an inherited trait or disorder, an acquired genetic alteration, a spontaneous genetic mutation, or is a carrier of a gene that could lead to a particular disorder or disease.

CommunityCare reimburses medically necessary genetic testing, genetic counseling, and human leukocyte antigen testing when it meets established coverage criteria and is performed by an approved provider. View the document below for more information.

Genetic Testing Payment Policy

Molecular Pre-Authorization Requisition Form

Many insurances are requiring pre-authorizations for genetic and molecular testing. If noted above the patient’s insurance company is requiring the ordering physician to obtain a pre-authorization before additional testing can be performed. The Hyperlink below will provide a printer friendly alert values pages. Once open click the Printer Icon on the left side in the toolbar just above the form.

Molecular Pre-Authorization Requisition Form