Who It's For
The Genetic Testing and Counseling Program includes a precertification requirement and medical necessity review for certain Tier 1 and all Tier 2 genetic testing codes, including those outlined below, that require genetic counseling. To determine if your patient’s plan requires precertification, please look for "Outpatient Procedures" listed on their Cigna ID card. The genetic test name is required for all submissions. The name of the gene (or genes) being tested is required for targeted panels. To request precertification, go to link. Additionally, genetic counseling may be required to obtain precertification for testing. If genetic counseling is required, please refer to Cigna's list of participating genetic counselors. As part of the precertification approval process, a Genetic Counseling Recommendation Form [PDF] or a Whole Exome Sequencing Recommendation Form [PDF] should be completed and submitted. Please refer to the coverage policy for additional information.
Please note that you must be a registered user to log in to CignaforHCP.com to submit precertification requests online. If you are not a registered user, go to CignaforHCP.com and click on "Register Now."
For a complete, up-to-date list of services that require precertification of coverage, health care providers can log in to Cigna for Health Care Professionals and click on "Precertification Policies" under "Useful Link copy." Once there, please see the "Master Precertification Policy" document.
Under Cigna-administered plans, prior to undergoing certain genetic tests, customers are required to get counseling from an independent genetics professional on our list of participating genetic counselors in order for precertification to be approved.
The program is designed to protect your patients and our customers:
- Genetic counseling provides individuals with the opportunity to become fully informed about complex genetic tests and make an informed decision about testing.
- Meeting with an independent genetics professional who is not employed by any clinical or genetic laboratory prevents conflict of interest between the counselor and the facility that performs the tests.
Medical necessity review and prior authorization helps ensure that individuals receive quality and cost-effective care that is covered under their benefit plans.
How It Works
Submit a precertification request formSubmit a precertification request form to determine if the genetic test requires genetic counseling. If genetic counseling is required, please see Step 2.
Refer the patientReview Cigna's list of participating genetic counselors and refer the patient to an independent board-certified genetic counselor or clinical geneticist.
Submit the requestThe genetic counselor or clinical geneticist typically submits the request, including:
- A completed genetic testing recommendation form, including the test or panel name(s), as well as gene name(s) for a targeted panel
- A three-generation pedigree
- A copy of the ordering health care provider’s laboratory requisition form
- A copy of your genetics evaluation documentation
Cigna review and decisionWe review the precertification request. We understand that many tests, especially the BRCA test, may be urgent. If the precertification request is approved, we will inform the ordering physician. If the precertification request is denied, standard appeal rights will be offered.
Genetic testing and follow-upThe genetics professional can facilitate the blood or specimen collection, genetic testing, and result interpretation. The genetics professional will refer the patient back to the ordering physician for ongoing management, providing them with a consultation report.
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