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Article | July 2016
Genetic Testing and Counseling Resources
Genetic counseling provides individuals with the opportunity to become fully informed about complex genetic tests.
Who It's For
The Genetic Testing and Counseling Program [PDF] 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 HealthcareSM 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 our list of participating genetic counselors. As part of the precertification approval process, a Genetic Counseling Recommendation Form or a Whole Exome and Whole Genome Sequencing Recommendation Form 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.
Program Objective
Under Cigna Healthcare-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 form
Submit a precertification request form to determine if the genetic test requires genetic counseling. If genetic counseling is required, please see Step 2.
Refer the patient
Review our list of participating genetic counselors and refer the patient to an independent board-certified genetic counselor or clinical geneticist.
Submit the request
The 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
Please fax the completed form and required copies to Cigna Healthcare at
Cigna Healthcare review and decision
We 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-up
The 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.
Breast and ovarian cancer (BRCA)
81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81432, and 81433
Colorectal cancer
81201, 81202, 81203, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81317, 81318, 81319, 81403, 81406, 81435, and 81436
Whole exome/genome testing
81415, 81416, 81417, 81425, 81426, 81427
Hereditary arrhythmias and cardiomyopathies (all hereditary cardiac tests)*
81403, 81404, 81405, 81406, 81407, 81408, 81413, 81414, 81439, S3861, S3865, and S3866
Hereditary cancer syndromes (all hereditary cancer tests)*
81162, 81163, 81164, 81165, 81166, 81167, 81201, 81202, 81203, 81212, 81215, 81216, 81217, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81317, 81318, 81319, 81321, 81322, 81323, 81401, 81403, 81404, 81406, 81432, 81433, 81435, 81436, 81437, 81438, S3840, S3841, and S3842
Long-QT
81406, 81413, and 81414
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