On Jan. 1, 2023, Point32Health entered into a collaboration with Foundation Medicine, Inc. (FMI) to expand access to comprehensive genomic profiling (CGP) for Harvard Pilgrim Health Care Commercial members and Tufts Health Plan Commercial members. We’re pleased to announce that we’ve broadened that expanded access, and the coverage now also applies to Tufts Health Together, Tufts Health RITogether, and Tufts Health Direct members.
Through this collaboration, we have expanded coverage for the FoundationOne®CDx (CPT 0037U) and FoundationOne®Liquid CDx (CPT 0239U) CGP tests, with prior authorization, for all eligible members who meet the criteria identified in the Medical Necessity Guidelines for Comprehensive Genomic Profiling with FoundationOne CDx or FoundationOne Liquid CDx to Guide Cancer Treatment in Patients with Advanced Cancer.
About FoundationOne CDx and FoundationOne Liquid CDx
FoundationOne CDx is an FDA-approved tissue-based comprehensive genomic profiling test. It is a qualitative next-generation sequencing based in vitro diagnostic test that uses targeted high throughput hybridization-based capture technology for detection of substitutions, insertion and deletion alterations (indels), and copy number alterations (CNAs) in 324 genes and select gene rearrangements, as well as genomic signatures including microsatellite instability (MSI) and tumor mutational burden (TMB). For more information, see the FoundationOne CDx Technical Information (FDA Label).
FoundationOne Liquid CDx is an FDA-approved blood-based comprehensive genomic profiling test. It is a qualitative next generation sequencing based in vitro diagnostic test that uses targeted high throughput hybridization-based capture technology to detect and report substitutions, insertions and deletions (indels) in 311 genes, rearrangements in four genes and copy number alterations in three genes. For more information, see the FoundationOne Liquid CDx Technical Information (FDA Label).
Requesting authorization
As a reminder, the genetic/genomic and molecular diagnostic testing authorization program for Harvard Pilgrim Commercial products and Tufts Health Public Plans is managed through an arrangement with Carelon Medical Benefits Management (formerly AIM Specialty Health®). For Harvard Pilgrim Commercial, Tufts Health Together, Tufts Health RITogether, and Tufts Health Direct members, please submit your authorization request for FoundationOne CDx or FoundationOne Liquid CDx online via Carelon’s portal at www.providerportal.com or by telephone at 855-574-6476.
For Tufts Health Plan Commercial members, you can continue to request prior authorization from Tufts Health Plan via the secure online provider portal.
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