New Payment Policy Effective May 1, 2022
Effective May 1, 2022: New Payment Policy - Genetic and Molecular Testing Services
Superior HealthPlan presents a new payment policy to communicate the expanded requirements for billing of molecular and genetic testing to advance the reliability of laboratory quality information and reduce variability in billing. As a result, the following policy has been added, and is posted on Superior’s Clinical, Payment and Pharmacy Policies website for review, prior to its implementation.
Genetic and Molecular Testing Services TX.PP.551
Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan, Medicare (Wellcare By Allwell)
New Policy Overview Or Updated Policy Revisions
To verify the accuracy of a test catalog and review coding engine standards for each molecular and genetic test, laboratories billing for genetic and molecular testing services should register using the Concert Genetics portal
The portal offers a quality metrics questionnaire for completion by laboratories that leverages industry-standard quality programs with customization to reflect the unique characteristics of genetic testing while being minimally burdensome on some providers.
Laboratories can also utilize the Concert Portal to obtain access to the Genetic Testing Unit, a unique identifier for every genetic test for billing and payment.