CommercialCoverageMedium impact
GeneSight Psychotropic Test
BCBS Arizona·AZ · Psychiatry, Family Medicine, Internal Medicine·Medical Policy
Effective date
Jul 1, 2025
We identified it
Jun 16, 2026
Summary
BCBS Arizona has established new medical necessity criteria for GeneSight Psychotropic genetic testing, requiring patients to have major depressive disorder or generalized anxiety disorder, have failed at least one prior medication, and meet strict documentation requirements including consideration of non-genetic factors before testing is approved.
Action Required
By July 1, 2025: Billing team must update prior authorization procedures for CPT 0345U (GeneSight Psychotropic test). Providers must document ALL required criteria: 1) Diagnosis of major depressive disorder or generalized anxiety disorder, 2) At least one failed prior medication, 3) Consideration of non-genetic factors including patient's diagnosis, medical conditions, other medications, and past medical history, 4) Clinical necessity for medication decision-making. Create documentation checklist for providers to ensure all criteria are met before ordering test to prevent claim denials.