Cologuard™, a stool-based colorectal cancer screening
test, and non-invasive prenatal testing/screening
(NIPT/NIPS) currently require precertification by
Independence for all commercial members. In addition,
CareCore National, LLC d/b/a eviCore healthcare
(eviCore), an independent specialty benefit management
company, manages the prepayment review for these
services on our behalf.
Effective October 15, 2016, the following changes
will apply:
- Cologuard™: Precertification will no
longer be
required by Independence. In addition, eviCore will
no longer manage the prepayment review for this
service. However, providers are still responsible for
ensuring that the individual?s medical record reflects
the medical necessity criteria for this service.
- NIPT/NIPS: Precertification will no longer be required
by Independence. However, eviCore will continue to
manage the prepayment review for this service.
- – The CPT codes that represent NIPT/NIPS are
81420, 81507, and 0009M.
Precertification list update and medical
policy changes
As a result of Cologuard™ and NIPT/NIPS no longer requiring
precertification, our updated precertification
requirement list will be available later this month on the Independence website.
The following text will be removed from the genetic and genomic tests
requiring precertification section:
- Stool-based colon cancer screening (Cologuard™)
- Non-invasive prenatal testing for Down syndrome and other common chromosome
abnormalities (such as
Harmony™, informaSeq®, Informed Pregnancy
Screen, MaterniT21®, Panorama®,
verifI®)
In addition, Medical Policy #06.02.52a: eviCore Lab Management Program will
be modified to reflect the change in
utilization management for these services. The updated policy will be posted to
the Medical Policy Portal at
on October 17, 2016. To view this policy after October 17, 2016, select
Accept and Go to
Medical Policy Online, then select Commercial, and type the
policy name or number in the Search field.
If you have any questions, please contact your Network Coordinator.
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