Precertification requirements

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. Three additional CPT codes (81210, 81300 and 81301) have been added to the precertification list beginning September 16, 2013. This will help ensure that individuals receive cost-effective care that is covered under their benefit plans.

For a complete, up-to-date list of services that require precertification of coverage, health care professionals should log in to our Cigna for Health Care Professionals website at CignaforHCP.com and click on "Precertification Policies" under "Popular Links." Once there, please see the "Master Precertification Policy" document.

Precertification requests may be submitted on the Cigna for Health Care Professionals website (CignaforHCP.com) or by calling the Cigna Customer Service Center at 1.800.88Cigna (882.4462).

As part of the updated precertification requirements, beginning September 16, 2013, individuals with Cigna-administered coverage will be required to receive pre-testing genetic counseling from an independent board-certified genetic counselor or clinical geneticist for three hereditary conditions breast and ovarian cancer (BRCA), colorectal cancer syndromes, and Long QT syndrome in order for precertification to be approved. This will provide these individuals with the opportunity to become fully informed about these complex genetic tests.

Prior to requesting precertification for these three conditions, ordering physicians should refer their patients with Cigna-administered coverage (and whose benefit plan requires precertification for outpatient procedures) to a participating independent board-certified genetic counselor or clinical geneticist for genetic counseling. This genetics professionals role will not only be to provide pre- and post-testing genetic counseling for individuals, but also to provide support to the ordering physician and help facilitate the overall testing process.

An independent genetics professional is one who is not employed by any clinical or genetic laboratory. Requiring that individuals receive services from an independent genetics professional ensures that there is no conflict of interest between the genetics professional and the facility that performs the tests.

For more information about how to find a genetic counselor, please review the information in the "Find a participating independent board-certified genetic counselor or clinical geneticist" section below.

Health care professionals and their patients can find a participating independent board-certified genetic counselor or clinical geneticist four different ways:

Please contact genetic counselors prior to receiving services to confirm that theyparticipate in Cigna's network.

To help ensure that individuals have ready access to genetics experts and expedited services, we have established a relationship with InformedDNA. InformedDNA is a nationwide network of participating independent board-certified genetic counselors who deliver services via telephone or web. Day, evening, and weekend appointments are available for individuals by telephone at home, and consultations for patients with urgent surgical or treatment decisions are scheduled within 24-48 hours of referral.

Once the ordering physician refers their patient to an independent board-certified genetic counselor or clinical geneticist, we will typically receive the clinical documentation for the counseling directly from the genetics professional.

In order to help genetic counselors and clinical geneticists facilitate their reviews, we will provide them with a form that will help them to clearly and efficiently make their recommendation regarding the proposed test. We will then use that recommendation and clinical documentation as part of our decision to approve or deny the precertification request.

Each precertification decision will be handled as follows:

We will do everything possible to help individuals receive the care they need as soon as they need it. We understand that many tests, especially the BRCA test, may be urgent. Thats why customers have access to many board certified-genetic counselors and clinical geneticists in our network.

Additionally, to help ensure that individuals have efficient access to genetics experts and expedited services, they can contact InformedDNA at 1.800.975.4819.

If a health care professional does not have Internet access to view these updates or if they would like additional information about our Genetic Testing and Counseling Program, they should contact their local Market Medical Executive or call Cigna Customer Service at 1.800.88Cigna (882.4462).

Customers can contact Customer Service at the telephone number on the back of their ID card for additional information about this program, or if they need help finding a participating independent board-certified genetic counselor.

The rest is here:
Genetic Testing and Counseling Program

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