Medicare AdvantagePrior AuthMedium impact
MA06.035a, Rapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic Disorders
Independence Blue Cross·Genetics, Pediatrics, Internal Medicine +1 more·Medical Policy
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Summary
This policy establishes coverage guidelines for Rapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for diagnosis of genetic disorders under Medicare Advantage plans, effective January 1, 2024. The billing team must verify medical necessity documentation and obtain prior authorization before submitting claims for these genetic sequencing services.
Action Required
By 06/16/2025 (within 30 days of policy posting): Billing team must review MA06.035a policy to identify applicable CPT/HCPCS codes for rWES and rWGS services. Update billing system to flag these services for prior authorization review before claim submission. Coordinate with providers to ensure genetic disorder diagnostic documentation is included with all rWES/rWGS claims. Contact payer's medical policy department to obtain specific billable codes if not listed in policy. Claims submitted without proper prior authorization will be denied by Medicare Advantage plans.