Home Providers Health Care Provider Resources Genetic Testing and Counseling Program

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 1 (855) 245-1104. If the genetic counselor’s recommendation is not to proceed with testing, we will call the ordering physician to discuss the request. At that time, the physician may withdraw the request, or ask for a coverage determination to be made.

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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