Genetic Screening and Testing Clinical Review Criteria — Coverage and Medical Necessity for Genetic & Molecular Tests
Clinical criteria governing coverage and medical necessity for a range of genetic and molecular tests (germline panels, somatic NGS for advanced cancer, cell-free fetal DNA, prenatal testing, pharmacogenomics) for Kaiser Foundation Health Plan of Washington members and providers.
Caris Life Sciences MI Cancer Seek (CDx) is listed as Considered Not Medically Necessary for non-Medicare.
Oncoplex (University of Washington) is included as a listed targeted genomic panel.
FoundationOne Liquid and FoundationOne CDx coding and medical-necessity distinctions updated: Medicare covered when criteria met; non-Medicare considered not medically necessary and preferred vendors should be used.
Preferred lab vendors (Caris, Oncoplex, Prevention, LabCorp, Quest-QNatal, etc.) and changes to preferred/non-covered lists have been updated multiple times.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.