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CONCERT GENETIC TESTING: Prenatal and Preconception Carrier Screening

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Defines medical necessity criteria and coding for carrier genetic testing (expanded and basic panels and gene-specific tests) for individuals considering pregnancy or who are currently pregnant, and for reproductive partners when indicated.

Policy Summary

PayerCommunity Health Plan Washington

PolicyPrenatal and Preconception Carrier Screening (Genetic Testing)

Policy CodePolicy N/A

Change TypeRevised criteria and codingadded CPT 81361expanded CFTR variant requirement

Effective DateN/A

Last ReviewNov 1, 2025

Next Review DateNov 1, 2025

Key ActionInclude relevant CPT/HCPCS codes and pregnancy/preconception indication on prior authorization requests; ensure documentation of counseling and family history.

SourceLink

POLICY UPDATE CHANGES

Updated criteria and coding for multiple carrier testing categories including addition of CPT 81361 to basic carrier screening panel and changes to CFTR variant testing breadth (23 -> 100 variants).

Clarified and separated FMR1 carrier screening criteria to distinguish carrier screening from diagnostic testing and added note about billing combination of 81243 with 81443 requiring Fragile X criteria.

Aligned HBA1/HBA2/HBB sequencing and deletion/duplication criteria with ACOG recommendations for universal hemoglobinopathy screening and added clarifying investigational statement excluding fetal hemoglobin testing via circulating fetal DNA.

CFTR, SMN1genes required on panels

<=14basic panel max genes

≥100CFTR variant minimum

81361CPT added

ACOG/ACMGprofessional societies cited

V2.2025policy version

Coverage and Medical Necessity Criteria

Expanded Carrier Screening Panels

Covered when ALL of the following are met

Expanded Carrier Screening Panels - coverage: Member is considering pregnancy or is currently pregnant AND panel includes CFTR and SMN1.

Expanded panels may be considered medically necessary when both conditions are met.

Basic Carrier Screening Panels

Covered when ALL of the following are met

Basic Carrier Screening Panels - coverage: Member is considering pregnancy or is currently pregnant AND panel includes CFTR and SMN1; panel consists of CFTR, SMN1/2, FMR1, HBB/HBA1/HBA2 and not more than 14 genes.<=14 genes

ACMG recommends follow-up testing of partner based on identified pathogenic/likely pathogenic variant; panels are not recommended to be completed by both partners in tandem.

Policy Summary

PayerCommunity Health Plan Washington

PolicyPrenatal and Preconception Carrier Screening (Genetic Testing)

Policy CodePolicy N/A

Change TypeRevised criteria and codingadded CPT 81361expanded CFTR variant requirement

Effective DateN/A

Last ReviewNov 1, 2025

Next Review DateNov 1, 2025

Key ActionInclude relevant CPT/HCPCS codes and pregnancy/preconception indication on prior authorization requests; ensure documentation of counseling and family history.

SourceLink

On This Page

DMD targeted and sequencing/deletion-duplication analysis

Considered medically necessary when ALL of the following are met:

DMD targeted: Member is considering pregnancy or is currently pregnant AND member has a close relative with a known pathogenic or likely pathogenic DMD variant.

Targeted analysis not supported for other indications.

DMD sequencing: Member is considering pregnancy or is currently pregnant AND member has a first- or second-degree relative diagnosed with Duchenne or Becker muscular dystrophy.

When familial pathogenic variant is unknown and an affected male is not available, female relatives should be offered both CNV analysis and sequencing (~99% sensitivity).

Expanded and Basic Carrier Screening Panels (professional guidance)

Professional society recommendations summarized:

ACOG guidance: ACOG states ethnic-specific, panethnic, and expanded carrier screening are acceptable strategies; all patients considering pregnancy or pregnant should be offered screening for CF and SMA and CBC/thalassemia screening.

After counseling, patients may decline testing.

ACMG tiering: ACMG recommends offering Tier 3 screening (carrier frequency ≥1/200) to all pregnant/planning patients; follow-up partner testing should target the same gene/variant identified in the member.

ACMG discourages offering lower tiers without Tier 3 and recommends Tier 4 only in consanguinity or specific family history.

Selected test-specific coverage criteria (present in this document window)

Covered when aligned with society guidance or specific clinical indications described below

Fragile X (FMR1) carrier screening: Offer FMR1 premutation carrier screening to women with family history of fragile X-related disorders or intellectual disability suggestive of fragile X, and to women with unexplained ovarian insufficiency or elevated FSH before age 40; provide follow-up genetic counseling and offer prenatal diagnostic testing to known carriers.

See ACOG practice bulletin No. 691 and ACMG Fragile X guidance

Spinal Muscular Atrophy (SMN1) screening: Offer SMA screening to all women considering pregnancy or currently pregnant; in those with family history, review affected individual's molecular testing and carrier testing of related parent before testing the partner; if reports unavailable, recommend SMN1 deletion testing for the low-risk partner.

ACOG and ACMG practice resources cited

Universal hemoglobinopathy testing: Offer universal hemoglobinopathy testing at the initial prenatal visit to individuals considering pregnancy or currently pregnant; testing may be hemoglobin electrophoresis or molecular expanded carrier screening.

ACOG Practice Advisory 2022

Ashkenazi Jewish carrier screening: Offer screening for CF, Canavan, familial dysautonomia, and Tay-Sachs to Ashkenazi Jewish individuals who are pregnant or considering pregnancy; consider additional conditions per ACOG; when only one partner is Ashkenazi Jewish, screen that partner first and offer testing to the other partner if a carrier is found.

ACOG Practice Bulletin No. 691

DMD (Dystrophinopathies) carrier testing: When familial pathogenic variant is unknown and an affected male is not available, female relatives at risk should be offered CNV analysis and sequencing since combined approaches give ~99% sensitivity; identify heterozygous females for potential cardiac surveillance.

EMQN and GeneReviews guidance

Each gene-specific carrier test included in the policy (examples: CFTR, SMN1/SMN2, FMR1, HBA1/HBA2/HBB, DMD, and Ashkenazi Jewish panels) is covered only when the stated pregnancy/preconception and family- or partner-specific criteria are met. For targeted variant analyses (e.g., CFTR targeted, SMN1 targeted, DMD targeted) the member typically must have a close relative with a known pathogenic or likely pathogenic variant; sequencing and/or deletion/duplication testing for genes such as CFTR, SMN1/SMN2, HBA/HBB, and DMD likewise require the member or partner to be considering pregnancy or currently pregnant (or the partner to be a known carrier) to meet medical necessity. The policy notes that these gene-specific tests are not supported for other indications outside the enumerated criteria.

Who and When Testing Is Covered

Individuals considering pregnancy or currently pregnant (and specific partner/family contexts as noted)

Covered when aligned with society guidance or specific clinical indications described below

Individuals considering pregnancy or currently pregnant: Most panels/tests require pregnancy/preconception indication; some tests require known family/pathogenic variants or partner carrier status.

Tests may be denied if not performed for individuals who are not considering pregnancy or currently pregnant or if panels do not include required genes (CFTR, SMN1).

Preconception or prenatal carrier screening when the member or their reproductive partner is considering pregnancy or is currently pregnant, often with additional family-history, ancestry, or partner-carrier conditions as specified per gene.

Covered when aligned with society guidance or specific clinical indications described below

Preconception or prenatal carrier screening indication: Preconception or prenatal carrier screening when the member or their reproductive partner is considering pregnancy or is currently pregnant, often with additional family-history, ancestry, or partner-carrier conditions as specified per gene.

Documentation should show pregnancy/preconception status and relevant family history; follow counseling guidance.

Fragile X premutation screening for women with family history suggestive of fragile X or women with unexplained ovarian insufficiency/elevated FSH before age 40

Covered when aligned with society guidance or specific clinical indications described below

Fragile X premutation screening - indication: Offer FMR1 premutation screening for women with family history suggestive of fragile X OR women with unexplained ovarian insufficiency/elevated FSH before age 40.

Follow-up genetic counseling and prenatal diagnostic testing offered to known carriers.

SMA screening for all women considering pregnancy or currently pregnant

Covered when aligned with society guidance or specific clinical indications described below

SMA screening - universal indication: Screening for SMA should be offered to all women considering pregnancy or currently pregnant.

In family history cases, review affected individual's molecular test reports and consider SMN1 deletion testing for low-risk partner if needed.

Universal hemoglobinopathy testing at initial prenatal visit for individuals considering pregnancy or currently pregnant

Covered when aligned with society guidance or specific clinical indications described below

Universal hemoglobinopathy testing: Offer universal hemoglobinopathy testing at the initial prenatal visit for individuals considering pregnancy or currently pregnant; testing may be hemoglobin electrophoresis or molecular expanded carrier screening.

Aligns with ACOG Practice Advisory 2022.

Ashkenazi Jewish carrier panel screening for CF, Canavan, familial dysautonomia, Tay-Sachs (and consideration of other listed disorders)

Covered when aligned with society guidance or specific clinical indications described below

Ashkenazi Jewish carrier panel - indication: Ashkenazi Jewish carrier panel screening for CF, Canavan, familial dysautonomia, Tay-Sachs (and consideration of other listed disorders) when member or partner is considering pregnancy or currently pregnant.

When only one partner is Ashkenazi Jewish, test that partner first; if positive, offer testing to the other partner.

Eligibility and Documentation Requirements

Eligibility for CFTR targeted variant analysis and for SMN1 targeted variant analysis requires that the member (or their reproductive partner) be considering pregnancy or currently pregnant and that the member have a close relative with a known pathogenic or likely pathogenic variant in the respective gene. These eligibility conditions are specified in the CFTR and SMN1 targeted criteria sets.

The detailed eligibility references indicate that 'close relatives' include first-, second-, and third-degree relatives on the same side of the family. For CFTR and SMN1 targeted testing, the policy requires documentation that a close relative has a known pathogenic or likely pathogenic variant in CFTR or SMN1, respectively, and that the member or partner is planning pregnancy or currently pregnant to meet medical necessity.

If family history documentation is unavailable, the criteria direct providers to review available molecular testing reports of affected individuals when possible; for SMN1 in particular, when familial reports are not available the guidance advises targeted deletion testing of the low-risk partner as part of the evaluation prior to partner testing.

For targeted variant analyses where a specific familial pathogenic/likely pathogenic variant is known in a relative, the policy supports targeted testing in the member when they meet the pregnancy/preconception requirement and have the qualifying family history; this is the expected pathway for CFTR and SMN1 targeted analyses.

Additional eligibility notes align with professional society recommendations: ACOG recommends offering CF carrier screening to all women considering pregnancy or who are pregnant and suggests review of family-member testing reports when available. ACMG technical standards inform CFTR variant reporting (including R117H and polyT reporting) and recommend that polyT status be reported when R117H is detected.

Operational eligibility notes for prior authorization and coding: basic carrier panels must include CFTR and SMN1 and be limited to not more than 14 genes; CPT coding updates (for example, addition of 81361 to represent hemoglobinopathy testing in basic panels) were included in the revisions and should be reflected in authorization submissions.

The policy and eligibility language were aligned with ACOG and ACMG guidance: providers are encouraged to follow these societies' recommendations for who should be offered screening (e.g., all pregnant or planning-pregnancy patients for CF and SMA) and to proceed after appropriate counseling. Documentation of counseling and family-history review supports eligibility determinations.

Billing Codes and Coding Notes

Referenced CPT/HCPCS Codes for carrier screening and gene-specific testingmixed

81243	FMR1 repeat analysis / Fragile X carrier (listed)
81257	HBA/HBB targeted variant analysis (listed)
81329	SMN1 sequencing/deletion-duplication (listed)
81336	SMN1/SMN2 related (listed)
81405	Targeted gene panel (listed)
81408	DMD sequencing/deletion-duplication (listed)
81443	Expanded panel (listed)
81479	Unlisted molecular pathology procedure (listed)
0400U	Proprietary test code (listed)
0449U	UNITY Carrier Screen (BillionToOne) (listed)

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Related ICD-10 Diagnosis Codes referencedICD-10

O09	Pregnancy supervision/encounter codes (listed)
Z13	Encounter for screening for genetic and chromosomal anomalies (listed)
Z31	Encounter for procreative management (listed)
Z34	Supervision of normal pregnancy (listed)
Z36	Antenatal screening (listed)
Z84	Family history of genetic disease (listed)
Z83.49	Family history of other specified conditions (listed)

Referenced CPT CodesCPT

81243

FMR1 repeat analysis (referenced as billed with additional carrier panel code)

Referenced CPT/HCPCS codes in revisions and reference tablemixed

81243	FMR1 repeat analysis (Fragile X) — referenced in billing combination note
81443	Exome/panel code referenced in combination with 81243 note
81361	Added CPT code for hemoglobinopathy tests included in basic carrier screening panel
81222	Referenced replacement in panel composition (CFTR/related?)
81223	Referenced replacement in panel composition (CFTR/related?)
81479	Unlisted molecular pathology procedure referenced as replacement in reference table edits
0236U	SMN2 Deletion/Duplication analysis (noted in criteria edits)

Basic carrier panel gene limit

Basic panel gene countBasic carrier screening panels consist of CFTR, SMN1/2, FMR1, HBB/HBA1/HBA2 and must include no more than 14 genes.

Panel examplesExamples of basic 14-gene panels include Inheritest 14-gene (Labcorp), Prenatal Carrier Panel (Quest), Foresight Fundamental (Myriad), UNITY Carrier Screen (0449U).

Coverage indicationBasic panels are medically necessary only when the member is considering pregnancy or is currently pregnant and the panel includes CFTR and SMN1.

CFTR variant minimum

ACMG minimum CFTR variant setACMG 2023 position statement recommends a minimum CFTR variant set of 100 variants for carrier screening.

PurposeThe 100-variant set supersedes the prior 23-variant recommendation and applies when CFTR carrier testing is pursued.

Policy alignmentCFTR sequencing/deletion-duplication panels in this policy reference the ACMG minimum variant set of 100 variants for carrier testing.

Basic panel gene count and ACMG tiers

Basic panel gene capBasic carrier screening panels include CFTR, SMN1/2, FMR1, HBB/HBA1/HBA2 and must contain not more than 14 genes.

ACMG Tier 3 recommendationACMG recommends offering Tier 3 carrier screening (carrier frequency ≥1/200) to all patients who are pregnant or planning pregnancy.

Panel strategy guidanceACOG accepts ethnic-specific, panethnic, and expanded carrier screening strategies and recommends offering CF and SMA screening to all patients considering pregnancy.

Actions Required by Ordering Providers

Prior Authorization

Submit codes and indication for authorization

Include the specific CPT/HCPCS procedure codes and the indication (pregnancy or preconception) when submitting prior authorization requests for carrier screening and gene-specific tests. The policy lists numerous codes that should be provided on authorization requests.

Provide the procedure code(s) from the policy reference table (examples include: 81220, 81221, 81243, 81329, 81361, 81443, 0449U).
Document that the member is considering pregnancy or is currently pregnant when requesting authorization.

Prior Authorization

Pregnancy/ancestry/family-history requirement

Order hemoglobinopathy panels (HBA1/HBA2/HBB sequencing or targeted) and Ashkenazi Jewish carrier panels only when the member (or reproductive partner) is considering pregnancy or currently pregnant and meets ancestry or family-history criteria specified in the policy.

If only one partner is Ashkenazi Jewish, test that partner first; test the other partner only if the Ashkenazi partner is positive.
Hemoglobinopathy testing may be performed by sequencing/deletion-duplication or targeted methods per the criteria.

Billing Rule

Updated panel coding — include CPT 81361

When requesting authorization for basic carrier screening panels that include hemoglobinopathy testing, include CPT code 81361 as part of the panel coding, reflecting the policy update to add 81361 to the basic panel PRT and criteria.

Ensure prior authorization and claims include CPT 81361 when the basic panel includes hemoglobinopathy testing.

Prior Authorization

Prior authorization may be required

Be aware that this clinical policy is intended to guide medical necessity determinations and may be used to assist coverage decisions; prior authorization may be required per plan administrative policies.

Follow plan-specific prior authorization procedures; the policy itself does not guarantee coverage.

Note

Step Therapy

Use targeted testing when familial pathogenic variants are known

If a familial pathogenic/likely pathogenic CFTR variant is confirmed in both biological parents or in an affected full sibling, targeted variant testing methods may be sufficient instead of comprehensive CFTR sequencing panels.

If familial variants are known, document the familial variant(s) and consider targeted testing rather than full gene sequencing per ACMG guidance.

Note

Documentation Required

Document pregnancy/preconception status and panel gene list; counsel patient

Document the member's pregnancy or preconception status and specify which genes are included on the ordered panel; pre- and post-test genetic counseling is strongly advised and should be documented when performed.

Record whether the member is considering pregnancy or currently pregnant on the order and authorization.
Document which genes are included in the panel and any counseling provided (pre- and/or post-test).

Documentation Required

FMR1 documentation — require ovarian insufficiency or pregnancy plus qualifying family history

For FMR1 (Fragile X) repeat analysis, provide documentation of either premature ovarian insufficiency or an elevated FSH level before age 40, or that the member is considering pregnancy or currently pregnant plus the qualifying family-history criteria listed in the policy.

If billing 81243 with a panel code (e.g., 81443), ensure the member still meets the Fragile X criteria in the policy.

Documentation Required

Review family history and molecular reports; document counseling

Prior to testing, review and include relevant family history and, when available, molecular testing reports of affected relatives; document this review and provide follow-up genetic counseling for identified carriers or intermediate/abnormal results.

If molecular reports of affected individuals are available, include them in the authorization/medical record review before ordering partner or family testing.
Document provision of follow-up genetic counseling when carriers or intermediate results are identified.

Documentation Required

Provide documentation consistent with coverage documents

Follow the member's coverage documents (evidence of coverage, certificate of coverage, policy, contract) when submitting claims or requesting coverage; the plan may require documentation consistent with those terms.

Provide supporting documentation as requested by the plan to demonstrate that testing meets the coverage criteria and the member's plan terms.

Denial Risk

Coverage limited to preconception/pregnancy indications — denial risk

Tests billed as carrier screening may be denied if performed for indications other than individuals considering pregnancy or currently pregnant, or if required genes (e.g., CFTR and SMN1) are not included on claimed expanded or basic panels.

Confirm the indication (preconception or prenatal) and panel composition before ordering and billing to avoid denial.

Denial Risk

CFTR polyT/TG testing allowed only with R117H present

Analysis of CFTR intron 9 polyT and TG regions is medically necessary only when the member or their reproductive partner is considering pregnancy or is currently pregnant AND the member is known to have the R117H CFTR variant; otherwise testing is not supported and may be denied.

Document presence of R117H variant when requesting polyT/TG analysis to meet coverage criteria.

Denial Risk

SMN1 targeted testing limited to pregnancy/preconception with qualifying family history

SMN1 targeted variant analysis for SMA carrier screening is limited to members (or their reproductive partner) who are considering pregnancy or currently pregnant and who have a close relative with a known pathogenic or likely pathogenic SMN1 variant; orders outside these criteria are not supported.

Document the qualifying close-relative SMN1 pathogenic/likely pathogenic variant when requesting targeted SMN1 testing.

Denial Risk

SMN1/SMN2 sequencing and CNV testing limited to pregnancy/preconception or partner carrier status

SMN1 sequencing/deletion-duplication and SMN2 analysis are considered medically necessary only for members (or their reproductive partners) who are considering pregnancy or currently pregnant, or when the partner is a known SMA carrier; use of these tests for other indications is not supported.

Document the reproductive context or partner carrier status when requesting SMN1/SMN2 sequencing or CNV testing.

Billing Rule

Billing combination note — 81243 with 81443 requires Fragile X criteria

If billing FMR1 repeat analysis (81243) together with a panel code such as 81443, ensure the patient meets the Fragile X carrier criteria in the policy; failure to meet Fragile X criteria when both codes are billed may result in denial.

When submitting claims that include both 81243 and 81443, include documentation that the member satisfies the Fragile X criteria (e.g., ovarian insufficiency or qualifying family history).

Denial Risk

Denial risk from plan coverage limits

Coverage decisions and benefit administration are subject to all terms, conditions, exclusions, and limitations of the member's coverage documents; absence of coverage in the plan documents may lead to claim denial despite meeting policy criteria.

Verify member eligibility and plan-specific coverage rules before ordering testing and submitting claims.

Excluded or Not Supported Uses

The policy specifies that screening indications outside of prenatal or preconception scenarios (or the explicit family/partner criteria) are not supported by current evidence. Tests performed for routine population screening, asymptomatic individuals not planning pregnancy, or other non-specified indications may be denied as not medically necessary.

Detailed not-covered language reiterates that expanded and basic carrier panels, CFTR targeted and sequencing approaches, CFTR polyT/TG analysis, and SMN1 targeted testing are not supported by current evidence when used for indications outside the pregnancy/preconception context or without meeting the specific family-history/partner criteria described in each test section.

The policy reference table was updated and certain prior listed panels and test codes were removed or replaced; examples include updates to CFTR variant testing minimums and addition of CPT 81361 to basic panel coding. Removed or renamed panel listings and code changes are reflected in the Policy Reference Table and supporting coding modules.

Definitions and Key Terms

Expanded carrier screening panel definition

DefinitionExpanded carrier screening: a multi-gene test performed for individuals considering pregnancy or who are pregnant that includes at minimum CFTR and SMN1.

Use caseOffered to individuals considering pregnancy or currently pregnant; may include many additional genes beyond basic panels.

Partner testingACMG recommends follow-up screening of the partner using analysis of the same gene if a pathogenic or likely pathogenic variant is identified in the member.

Basic carrier screening panel definition

DefinitionBasic carrier screening panel: a panel that includes CFTR, SMN1/2, FMR1, and HBB/HBA1/HBA2 and contains not more than 14 genes, intended for individuals considering pregnancy or who are pregnant.

Examples and codesExamples include several commercial 14-gene prenatal panels; related CPT/HCPCS and ICD codes are listed in the policy coding section.

Coverage limitationBasic panels are medically necessary only for members considering pregnancy or currently pregnant and when the panel includes CFTR and SMN1.

Tier 3 carrier screening (ACMG) definition

DefinitionTier 3 carrier screening (ACMG): genes with carrier frequency ≥1/200; ACMG recommends offering Tier 3 screening to all pregnant patients and those planning pregnancy.

Tiering overviewACMG tiered system: Tier 1 (CF+SMA+risk-based), Tier 2 (≥1/100), Tier 3 (≥1/200, includes X-linked), Tier 4 for consanguinity or warranted history.

Partner offerReproductive partners may be offered Tier 3 screening when performed simultaneously with their partner or as follow-up when a partner is identified as a carrier.

CFTR minimum variant set definition

DefinitionCFTR minimum variant set: ACMG 2023 position statement recommends testing a minimum set of 100 CFTR variants for carrier screening.

Supersedes prior setThe 100-variant set replaces the previous ACMG recommended set of 23 CFTR variants.

Policy implicationCFTR sequencing/deletion/duplication criteria in this policy reference the ACMG minimum 100-variant recommendation for carrier testing.

Close relatives definition

DefinitionClose relatives: first-, second-, and third-degree relatives on the same side of the family.

First-degree examplesParents, siblings, and children.

Second-/third-degree examplesSecond-degree: grandparents, aunts/uncles, nieces/nephews, grandchildren, half-siblings. Third-degree: great-grandparents, great aunts/uncles, great grandchildren, first cousins.

Clinical policy definition

DefinitionClinical policy: a guide to medical necessity developed from review of standards of practice, literature, and professional guidelines to assist coverage decisions.

ScopeProvides guidance for coverage determinations but does not guarantee payment; coverage subject to plan terms, exclusions, and applicable laws.

Intended useUsed to assist in making coverage decisions and administering benefits; not a substitute for clinical judgment or counseling.

Policy Updates and Revision Notes

2025-11-01policy_reviewLatest

Policy last reviewed (document lists last_review 2025-11-01) and updated to version V2.2025 per internal tracking.

2024-11-00criteria_and_coding_update

Added CPT 81361 to the Basic Carrier Screening Panel Policy Reference Table and criteria to reflect inclusion of hemoglobinopathy testing; updated FMR1 criteria name to distinguish carrier screening from diagnostic testing and updated Policy Reference Table entries.

2024-04-00criteria_update

Aligned HBA1/HBA2/HBB sequencing and deletion/duplication criteria with ACOG recommendations and updated CFTR sequencing variant count from 23 to 100 consistent with 2023 ACMG CFTR guidance; clarified investigational statement excluding fetal hemoglobin testing via circulating fetal DNA.

2024-01-24technical_revision

Changed number of tested CFTR variants in CFTR Sequencing/Deletion/Duplication criteria from 23 to 100 and updated background text to reflect the 2023 ACMG statement on CFTR variant testing (approval date 01/24).

CONCERT GENETIC TESTING: Prenatal and Preconception Carrier Screening

Sign up for all Community Health Plan Washington policy alerts

Coverage and Medical Necessity Criteria

Who and When Testing Is Covered

Eligibility and Documentation Requirements

Billing Codes and Coding Notes

Actions Required by Ordering Providers

Excluded or Not Supported Uses

Definitions and Key Terms

Background and Rationale

Policy Updates and Revision Notes