Policy Updates for Concert Genetics

Date: 08/09/23

MHS Health Wisconsin is retiring the clinical policies in the range of CP.MP.215 to CP.MP.241, which contained criteria from Concert Genetics, and is replacing them with Concert Genetics policies that will be offered by Change HealthCare within the InterQual^® clinical decision support platform as "Concert Genetics Navigator" criteria. The Concert Genetics Navigator reflects criteria from the Concert Genetics clinical policies and will be updated semi-annually. The Concert Genetics Navigator criteria (containing the same information as the Concert Genetics clinical policies listed below) will be cited in genetic testing utilization management determinations, when applicable.

These changes are effective beginning September 10, 2023. 

The Concert Genetics clinical policies are provided for reference.

• CP.MP.215 Genetic Testing Aortopathies and Connective Tissue Disorders
  • Retired and replaced by Concert Genetics Genetic Testing Aortopathies and Connective Tissue Disorders V2.2023
• CP.MP.216 Genetic Testing Cardiac Disorders
  • Retired and replaced by Concert Genetics Genetic Testing Cardiac Disorders V2.2023
• CP.MP.217 Genetic Testing Dermatologic Conditions
  • Retired and replaced by Concert Genetics Genetic Testing Dermatologic Conditions V2.2023
• CP.MP.218 Genetic Testing Epilepsy Neurodegenerative and Neuromuscular Disorders
  • Retired and replaced by Concert Genetics Genetic Testing Epilepsy, Neurodegenerative, and Neuromuscular Conditions V2.2023
• CP.MP.219 Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders
  •  Retired and replaced by Concert Genetics Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders V2.2023
• CP.MP.220 Genetic Testing Eye Disorders
  •  Retired and replaced by Concert Genetics Genetic Testing Eye Disorders V2.2023
• CP.MP.221 Genetic Testing Gastroenterologic Disorders (non-cancerous)
  •  Retired and replaced by Concert Genetics Genetic Testing Gastroenterologic Disorders (non-cancerous) V2.2023
• CP.MP.222 Genetic Testing General Approach to Genetic Testing
  • Retired and replaced by Concert Genetics Genetic Testing General Approach to Genetic Testing V2.2023
• CP.MP.223 Genetic Testing Hearing Loss
  • Retired and replaced by Concert Genetics Genetic Testing Hearing Loss V2.2023
• CP.MP.224 Genetic Testing Hematologic Condition (non-cancerous)
  • Retired and replaced by Concert Genetics Genetic Testing Hematologic Condition (non-cancerous) V2.2023
• CP.MP.225 Genetic Testing Hereditary Cancer Susceptibility
  • Retired and replaced by Concert Genetics Genetic Testing Hereditary Cancer Susceptibility V2.2023
• CP.MP.226 Genetic Testing Immune, Autoimmune, and Rheumatoid Disorders
  • Retired and replaced by Concert Genetics Genetic Testing Immune, Autoimmune, and Rheumatoid Disorders V2.2023
• CP.MP.227 Genetic Testing Kidney Disorders
  • Retired and replaced by Concert Genetics Genetic Testing Kidney Disorders V2.2023
• CP.MP.228 Genetic Testing Lung Disorders
  • Retired and replaced by Concert Genetics Genetic Testing Lung Disorders V2.2023
• CP.MP.229 Genetic Testing Metabolic Endocrine and Mitochondrial Disorders
  • Retired and replaced by Concert Genetics Genetic Testing Metabolic, Endocrine, and Mitochondrial Disorders
• CP.MP.230 Genetic Testing Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
  • Retired and replaced by Concert Genetics Genetic Testing Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay V2.2023
• CP.MP.231 Genetic Testing for Non-Invasive Prenatal Screening (NIPS)
  • Retired and replaced by Concert Genetics Genetic Testing Non-Invasive Prenatal Screening (NIPS) V2.2023
• CP.MP.232 Genetic Testing Pharmacogenetics
  • Retired and replaced by Concert Genetics Genetic Testing Pharmacogenetics V2.2023
• CP.MP.233 Genetic Testing Preimplantation Genetic Testing
  • Retired and replaced by Concert Genetics Genetic Testing Preimplantation Genetic Testing V2.2023
• CP.MP.234 Genetic Testing Prenatal and Preconception Carrier Screening
  • Retired and replaced by Concert Genetics Genetic Testing Prenatal and Preconception Carrier Screening V2.2023
• CP.MP.235 Genetic Testing Prenatal Diagnosis
  • Retired and replaced by Concert Genetics Genetic Testing Prenatal Diagnosis via Amniocentesis, CVS or PUBS and Pregnancy Loss V2.2023
• CP.MP.236 Genetic Testing Skeletal Dysplasia and Rare Bone Disorders
  • Retired and replaced by Concert Genetics Genetic Testing Skeletal Dysplasia and Rare Bone Disorders V2.2023
• CP.MP.237 Genetic Testing Oncology Algorithmic Testing
  • Retired and replaced by Concert Genetics Oncology Algorithmic Testing V2.2023
• CP.MP.238 Genetic Testing Oncology Cancer Screening
  • Retired and replaced by Concert Genetics Oncology Cancer Screening V2.2023
• CP.MP.239 Oncology Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy)
  • Retired and replaced by Concert Genetics Oncology Circulating Tumor DNA and Circulating Tumor Cells Liquid Biopsy V2.2023
• CP.MP.240 Genetic Testing Oncology Cytogenetic Testing
  • Retired and replaced by Concert Genetics Oncology Cytogenetic Testing V2.2023
• CP.MP.241 Genetic Testing Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies
  • Retired and replaced by Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies V2.2023

Thank you for being a valued partner in caring for the health and well-being of our members. If you have any questions about the policy changes listed above or any of our Clinical & Payment Policies, please contact your Provider Relations representative or call the Provider Inquiry Line at 1-800-222-9831. If you are unsure of your representative, please email us at WI_Provider_Relations@mhswi.com.