Molecular and Genomic Testing Program Update: October 2026

We are making the following changes to our Molecular and Genomic Testing Program administered by EviCore Healthcare (EviCore).

Codes to be Added to The Program

EviCore will conduct pre-service Medical Necessity Determination (MND) reviews of the new CPT® Proprietary Laboratory Analyses (PLA) Codes listed below when provided on or after October 1, 2026 in a physician's office or clinical laboratory, as part of this program.

Codes to be Removed from the Program

eviCore will no longer conduct pre-service MND reviews for the codes listed below for services provided on or after October 1, 2026.

• 0585U

Review the complete list of molecular and genomic diagnostic testing services subject to MND review.

EviCore by Evernorth is an independent company that has contracted with Horizon BCBSNJ to perform Medical Necessity Determination reviews of certain molecular and genomic diagnostic testing services that are rendered in a physician's office or clinical laboratory setting. MND requirements do not apply to molecular and genomic diagnostic testing services rendered to patients in a hospital Emergency Room (ER), hospital outpatient or inpatient setting or an Ambulatory Surgery Center (ASC).

CPT® is a registered trademark of the American Medical Association.

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