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Prior Authorization Required for Genetic Testing in 2019

Beginning January 1, 2019, Blue Cross Blue Shield of Massachusetts will require prior authorization before covering certain genetic tests. Prior authorization helps us manage costs by ensuring your employees receive services that are clinically appropriate and medically necessary. The following genetic tests will require prior authorization:

  • DNA testing of hereditary heart disease risks
  • DNA testing of hereditary cancer risks
  • Testing to detect changes in DNA which may indicate a specific disease or condition
  • Testing to help select proper medication and dosing regimens
  • Prenatal screening and diagnosis of specific conditions
  • DNA testing of tumor cells
  • DNA sequencing to understand a current health or medical issue

Doctors who request prior authorization for these services may also suggest genetic counseling to help employees better understand the procedure and its results.

This change will only apply to members on our Commercial HMO/POS and Commercial PPO plans.

Blue Cross Blue Shield of Massachusetts

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