Genetic testing

Prevea360 Health Plan updated medical policies for Genetic Testing in June 2017, and continues to update policies biannually on an ongoing basis. As genetic testing has increasingly become the standard of care, Prevea360 Health Plan is committed to the access and quality of these services for our members. Our current genetic testing policies were developed by our contracted vendor Concert Genetics, an industry leader in genetic testing technology assessment and policy development.

Here are a few things to consider:

  • General Approach to Genetic Testing Medical Policy MP9610, describes the general approach for any genetic testing not specifically addressed in another policy. It also serves as the general policy for genetic testing and will provide links to specific genetic tests.
  • Genetic tests must meet applicable evidenced based guidelines and be medically necessary. 
  • Genetic counseling and medical necessity requirements may be test specific, as identified within each medical policy.
  • Medical necessity criteria will be applied to Commercial HMO, POS, PPO and ASO members.
  • ASO members are excluded from any Genetic Counseling requirements.
  • For laboratories only — Every genetic test is assigned a genetic testing unit (GTU), a unique alphanumeric identifier for payers who utilize Concert Genetic services. This unique GTU may be found on the Concert Genetic Platform. Every genetic test has been assigned a GTU. Log in at to find the GTU for your requested genetic test.

Genetic testing - prior authorization

For services that require authorization, submit prior authorization requests via the Prevea360 Health Plan provider portal

View a list of genetic tests that require prior authorization.

Providers without portal access may fax the genetic testing prior authorization form to the number indicated on the form. 

Genetic counseling requirement

Certain tests require pre-test and post- test genetic counseling. Prior authorization is not required for referrals to a genetic counselor.

Genetic Counseling Resources

St. Vincent Genetic Counseling department can provide genetic counseling for Prevea360 Health Plan members.

Members can be referred to St. Vincent Genetic Counseling at 920-433-8559 (fax 920-431-3138). Additionally, if there are in-network providers who employ genetic counselors may continue to use a current process that may be in place to comply with Prevea360 Health Plan’s updated genetics testing medical policies where genetic counseling is required.

Prevea360 Health Plan recognizes the limited accessibility of genetic counselors. We've partnered with InformedDNA (IDNA) to provide telephonic genetic counseling services for Prevea360 Health Plan members. The goal is to improve member satisfaction and ease the burden for our providers. 

If no genetic counselors are available within your organization or there is an access issue, Prevea360 Health Plan’s member may be referred to InformedDNA (IDNA). Use the IDNA Cancer Genetic Counseling Referral form or the Cardiac Genetic Counseling Referral form to refer to IDNA.