Medicare AdvantageCoverageHigh impact
Concert Genetics Policies
Ambetter·NE · Infectious Disease, Family Medicine, Internal Medicine +4 more·Claims & Billing
Effective date
Sep 1, 2026
We identified it
Aug 26, 2026
Summary
Ambetter Health is implementing seven new Concert Genetics policies effective September 1, 2026, establishing clinical and payment criteria for infectious disease lab testing across multiple categories (respiratory, multi-system, dermatologic, gastroenterologic, preventive screening, vector-borne, and genitourinary). A new laboratory payment policy (CG.CC.PP.01) outlines correct coding requirements for lab and molecular testing. Billing teams must obtain and review the full policy text to identify specific coding impacts and prior authorization requirements.
Action Required
By August 15, 2026: Billing team must request full policy text from Ambetter Health Provider Services (1-833-890-0329, TTY 711) for all seven Concert Genetics policies (CG.CP.MP.01 through CG.CP.MP.07 and CG.CC.PP.01). Review policies to identify: (1) specific CPT/HCPCS codes affected, (2) prior authorization requirements, (3) medical necessity criteria, and (4) coding rule changes. Update billing software, encounter forms, and provider documentation templates accordingly. Before September 1, 2026: Train billing staff and providers on new requirements. Communicate any prior auth workflows or coding changes to clinical staff. Failure to comply may result in claim denials for infectious disease lab testing.