Genetic Testing Medical Policies

Commercial | QUEST Integration | Medicare Advantage

Hawaii Medical Service Association (HMSA) partners with Avalon Healthcare Solutions (AHS) to streamline the management of genetic testing services. AHS and HMSA review genetic testing medical policies and services using the HRS-432 - Hawaii State Statute for Medical Necessity. For full medical necessity criteria, refer to to the genetic testing medical policies below.
For a listing of non-covered genetic testing codes, refer to Codes That Do Not Meet Payment Determination Criteria - Table I. Other relevant information may be found on HMSA’s Pathology and Lab - Claim Documentation Requirements page.

Precertification

Precertification is required for GTM. Please refer to the Genetic Testing Management (GTM) Utilization Review Matrix for a comprehensive listing of service codes which AHS manages on behalf of HMSA. All lines of business – commercial, Medicare, and QUEST Integration – are subject to AHS’ precertification review. Providers may submit precertification requests and/or questions 24/7 via AHS’:
 

Prior Authorization System (PAS) Portal
Phone: (844) 227-5769
Fax: (813) 751-3760

• Frequently Asked Questions For Providers - Genetic Testing Management
• HMSA Authorization Request Form

CURRENT GENETIC TESTING MEDICAL POLICIES

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ARCHIVED GTM POLICIES
Unless otherwise noted, archived policies are inactive. Since archived policies are not updated, these policies will no longer be used when reviewing requests for coverage and these services will no longer require prior authorization, unless noted.
 

Revision History