CurrentAmbetter NevadaPolicy N/A

Concert Genetic Testing: Identity and Forensics (PDF)

Policy governs coverage of genetic tests performed to confirm the identity or provenance of laboratory specimens (e.g., 'know error' DSPA) and states the insurer's position regarding separate billing and medical necessity for these tests.

Policy Summary

PayerAmbetter Nevada

PolicyConcert Genetic Testing: Identity and Forensics (PDF)

Policy CodePolicy N/A

Change TypeRevised — new standalone policy; wording updated

Effective Date

Next Review Date

Key ActionProviders should not expect separate coverage when billing genetic testing to confirm specimen identity because the policy states such testing is generally considered an existing component of genetic testing quality assurance and current evidence does not support separate billing.

SourceLink

POLICY UPDATE CHANGES

New policy created; criteria previously in Concert Genetic Testing: Oncology were moved and the statement changed from 'investigational' to 'current evidence does not support.'

1Primary coverage position (not supported)

3Example CPT/ICD codes referenced

Coverage Summary

Policy governs coverage of genetic tests performed to confirm the identity or provenance of laboratory specimens (e.g., "know error" DSPA) and states the insurer's position regarding separate billing and medical necessity for these tests. Primary position: not supported / not covered when billed separately. The Know Error DNA Specimen Provenance Assay (DSPA) is referenced as an example assay used to confirm specimen identity.

Key facts

Primary coverage positionCurrent evidence does not support genetic testing to confirm laboratory specimen identity when billed separately; considered part of standard genetic testing quality assurance (not supported)

Example CPT codes referenced81265, 81266, 81479

Referenced ICD-10 rangeC00.0-D49

StatusCURRENT

Last review date2024-11-25

PayerAmbetter Nevada

Policy titleConcert Genetic Testing: Identity and Forensics

Medical Necessity / Policy Statement

Genetic Testing to Confirm the Identity of Laboratory Specimens

Covered/Not covered when meeting the following policy statement:

Current evidence does not support genetic testing to confirm the identity of laboratory specimens (e.g., know error), when billed separately, for all indications, because it is generally considered to be an existing component of the genetic testing process for quality assurance.

Provider Actions & Billing Guidance

Documentation Required

Do not bill separately for specimen identity testing

Providers should not expect separate coverage when billing genetic testing performed solely to confirm specimen identity or provenance. The policy states that current evidence does not support genetic testing to confirm the identity of laboratory specimens when billed separately because specimen identity confirmation is generally considered part of the standard quality assurance process for genetic testing.

81265 — May be denied if billed separately (specimen identity confirmation generally considered QA).
81266 — May be denied if billed separately (specimen identity confirmation generally considered QA).
81479 — May be denied if billed separately (specimen identity confirmation generally considered QA).

Background

This policy addresses tests used to confirm laboratory specimen identity and provenance. It explains that separate billing for such identity confirmation is generally not supported because confirmation of specimen identity is considered part of the standard quality assurance process in genetic testing and current evidence does not support separate billing when billed independently.

Know Error DNA Specimen Provenance Assay (DSPA): an example assay (Strand Diagnostics, LLC) referenced as a test to confirm specimen identity.

Revision History

revisedLatest

Coding table and rationale updated; new policy created; statement changed from investigational to current evidence does not support. Detail: New policy created. Criteria previously found in Concert Genetic Testing: Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies. Review of criteria with no changes except to change the statement from noting the test is 'investigational' to stating that 'current evidence does not support.' Coding table and rationale updated.

Policy Summary

PayerAmbetter Nevada

PolicyConcert Genetic Testing: Identity and Forensics (PDF)

Policy CodePolicy N/A

Change TypeRevised — new standalone policy; wording updated

Effective Date

Next Review Date

SourceLink

On This Page

81265
81266
81479