Beginning November 1, 2024, EviCore by Evernorth^® will begin managing precertification for certain Current Procedural Terminology (CPT^®) codes for molecular laboratory tests for Cigna Healthcare^℠ customers.

Additionally, we will no longer require customers to receive genetic counseling prior to obtaining precertification for genetic testing.^*

Precertification requirements

Precertification for laboratory tests delegated to EviCore must be obtained prior to the service being rendered in an office or outpatient setting. It is the responsibility of the performing laboratory to confirm that the rendering physician completed the precertification process for molecular and genomic testing.

For a complete list of CPT codes included in this program, go to EviCore.com/resources/healthplan/Cigna > Solution Resources > Laboratory Management > CPT Codes.

Testing included in the program

This program ensures appropriate use of molecular (genomic) testing through evidence-based clinical policies, medical necessity review, and claims payment rules.

There are more than 70,000 available genetic tests, with new tests added quarterly. EviCore’s precertification process reviews requests to ensure there is sufficient clinical evidence to support the use of the test.

Provider orientation sessions

In October and November, EviCore will lead online sessions to help you and your staff understand the new precertification process. These sessions will include detailed information about the process, a review of how to access information on EviCore.com, and a question-and-answer period.

Please refer to these additional details and registration instructions. We encourage you and your staff to attend one of these sessions to ensure understanding of the precertification program requirements.

*While genetic counseling will no longer be required to obtain precertification for genetic testing, we continue to recognize the value of counseling and encourage all customers considering genetic testing to consult an independent genetic counselor. Genetic counseling provides individuals with the opportunity to fully understand complex genetic tests and make an informed decision about testing. Please refer to our list of participating genetic counselors.