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Implementation of CC.PP.551A Genetic and Molecular Testing Services

Date: 08/28/25

New Billing Requirements for Genetic and Molecular Testing Services

Effective October 1, 2025, Arizona Complete Health is implementing payment policy CC.PP.551A Genetic and Molecular Testing Services for Medicaid (Arizona Complete Care Plan), Marketplace (Ambetter from Arizona Complete Health), and Medicare (Wellcare by Allwell (HMO) and Wellcare (PPO)) lines of business.

Advancements in the science of genetics and genomics have led to new options for medical professionals to diagnose, treat, and prevent disease. As genetic testing has increasingly become the standard of care, we are committed to providing the highest levels of access, quality, and value for members. To achieve these goals, we ask for your support to advance the reliability of laboratory quality information and reduce variability in billing.

The quality and billing integrity requirements included in CC.PP.551A Genetic and Molecular Testing Services will be facilitated by Concert Genetics (Concert), our partner and a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of genetic testing and precision medicine.

Next Steps for Labs:

  •  Register with Concert www.concertgenetics.com/join-centene to:
    • Self-report on quality metrics in a common framework supplied by Concert
    • Verify accuracy of test catalog and view coding recommendations
    • Access Concert GTUs and descriptors
      • Include the Concert GTU descriptor to all prior authorization requests
      • The Concert GTU is required in the procedure description of the claim (e.g. “GTU- 6V98G” or “6V98G”)
  • Utilize Concert’s recommended codes when billing for genetic and molecular tests

References:

If you have questions, please contact your Provider Engagement Account Manager. If you need your assigned Provider Engagement Account Manager’s contact information, please email us: AzCHProviderEngagement@azcompletehealth.com.