- Aetna HMO*
- Aetna Elect Choice
- Aetna QPOS
- Aetna Select
- Aetna Managed Choice POS
- Aetna Choice POS II
- Aetna Open Access Student MC
- Aetna Signature Administrators
- Aetna Joint Claims Administration
- Aetna Passport to Healthcare
- Aetna PPO
- Aetna National Advantage
- Aetna National/First Health Network
- AmeriGroup Kansas
- AmeriGroup Texas
- Anthem California
- BeechStreet - PPO
- BlueCross BlueShield of Arizona
- BlueCross & BlueShield TX Blue Essentials HMO*
- BlueCross & BlueShield TX PAR Indemnity
- BlueCross & BlueShield TX Health Select
- BlueCross & BlueShield TX PPO – Blue Choice
- BlueCross & BlueShield of Illinois PPO
- CIGNA HMO*
- CIGNA PPO
- Community Health Choice – Community Marketplace
- FedMed
- Health Spring-Renaissance IPA
- Humana Commercial PPO
- Humana HMO*
- Humana POS
- Humana EPO
- Humana HMO Premiere*
- Humana Choice Care Commercial PPO
- Humana Choice Care POS
- Humana Military - Tricare*
- (New Tricare East, including North and South regions)
- Mail Handlers Benefit Plan
- Maine Community Health Option
- Memorial Hermann Health Solutions Inc. Choice
- Memorial Hermann Health Solutions Inc. EDGE
- Memorial Hermann Health Solutions Inc. PPO
- Molina Health Care of Texas HMO
- MultiPlan
- OSU Health Plan
- Ped-I-Care (Florida)
- Physicians Health Plan of Northern Indiana (PHPNI)
- POMCO [Government]
- Scott & White Health Plan HMO
- Scott & White Health Plan PPO
- Seton Health Plan PPO
- Seton Health Plan EPO
- Stratose [Network]
- SummaCare Ohio
- Texas Children's Health Plan
- Texas Health and Human Services [Government]
- Three Rivers Provider Network
- United Healthcare [Commercial]*
- United Healthcare Empire Plan (New York)
- Wellmark Iowa
- Wellmark South Dakota
Medicaid*
The Medicaid policies listed below require prior authorization by an ordering provider.
Effective immediately, TX Medicaid and TX Managed Medicaid will no longer process prior authorizations or provide reimbursement for testing that is non-covered by the TX Medicaid fee schedule.
Examples include 81415, 81416, 81479, 81228, 81229, 81460, and 81465, which primarily affect Whole Exome Sequencing (WES), Chromosomal Microarray Analysis (CMA,) Comprehensive Mitochondrial Analysis, and any testing coded with 81479.
Always double check the most recent TX Medicaid fee schedule before requesting a prior authorization.
- BlueCross & BlueShield TX CHIP
- BlueCross & BlueShield TX STAR
- BlueCross & BlueShield TX STAR Kids
- Community Health Choice Inc. CHIP
- Community Health Choice Inc. STAR
- Cook Childrens Health Plan CHIP
- Cook Childrens Health Plan STAR
- Dell Children’s Health Plan CHIP
- Dell Children’s Health Plan STAR
- Molina Health Care of Texas CHIP
- Molina Health Care of Texas STAR
- Molina Texas Medicaid STAR+PLUS
- Scott & White HealthPlan Medicaid CHIP
- Seton Health Plan STAR
- Seton Health Plan CHIP
- Superior HealthPlan CHIP
- Superior HealthPlan Medicaid
- Superior HealthPlan STAR
- Superior HealthPlan STAR Kids
- Superior HealthPlan STAR Health
- Superior HealthPlan STAR+PLUS
- UnitedHealthcare Community Plan of Texas
State Medicaid
- Alabama
- Arizona
- Colorado
- Delaware
- Georgia
- Florida
- Indiana
- Iowa
- Kansas
- Maine
- Maryland
- Michigan
- Missouri
- Nebraska
- New Mexico
- New Jersey
- New York
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- South Carolina
- Tennessee
- Texas
- Wisconsin
- Virginia
Medicare*
We are a certified Medicare provider. The patient must meet Medicare’s specific testing criteria for genetic tests. A completed Advanced Beneficiary Notification (ABN) form is required if the patient does not meet the criteria.