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. 


Policy

  • Genetic and Molecular Testing Services TX.PP.551

Effective Date 

  • 05/01/2022

Applicable Products 

  • 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. 


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