Effective October 1, 2025: New Prior Authorization Requirement for Certain Genetic and Molecular Testing

Date: 07/16/25

Effective October 1, 2025, certain genetic services testing procedure codes will require prior authorization for procedure codes for Ambetter from Superior HealthPlan members.

Prior authorization requests should be submitted to Evolent's website, by calling 1-800-642-7554 or fax to 1-800-784-6864.

Ambetter ensures medical necessity review criteria is current and appropriate for members and the scope of services provided. Below are the Current Procedural Terminology (CPT) codes included in this change to the prior authorization requirements.

Evolent’s genetic testing clinical guidelines that will be utilized for these services can be found on Evolent’s Genetic Testing Policies webpage.

Ambetter Required Prior Authorization:

CPT Codes	Description	Criteria Source
0345U	PSYC GENOMIC ALYS PANEL VARIANT ALYS 15 GENES	Evolent’s genetic testing clinical guidelines that will be utilized for these services can be found on Evolent’s Genetic Testing Policies webpage.

To review Evolent’s prior authorization requirements, please visit Evolent's website.

For questions or additional information, contact Ambetter’s Prior Authorization department at 1-877-687-1196.