Many insurance plans require prior authorization in order to perform genetic testing. When a request for prior authorization is made, it’s important to include a letter of medical necessity that explains why Athena’s testing services are needed. Below you will find letters for several of Athena’s commonly ordered tests.
Use the letter with your initial request for prior authorization. If the insurance company denies your request, include the appeal letter with your appeal of their denial.
Generic Letter of Medical Necessity
Letter
CNS Autoantibodies
Complete Paraneoplastic Evaluation - Test Code 467
Paraneoplastic Neurological Syndromes, Initial Assessment - Test Code 4500
Epilepsy
Epilepsy Advanced
Sequencing and CNV Evaluation
Epilepsy Sub panels
Generalized, Absence,
Focal, Febrile, and Myoclonic Epilepsies
Epileptic
Encephalopathy
Developmental Brain
Malformations
Intellectual
Disability
Neuronal Ceroid
Lipofuscinosis
Epilepsy with
Migraine
Syndromic
Disorders
Infantile Spasms
Complete SCN1A
Evaluation
Peripheral Neuropathy
CMT Advanced Evaluation Comprehensive – Test Code 4001
CMT Advanced Evaluation - Initial Genetic Assessment - Test Code 4010
SensoriMotor Neuropathy Profile - Complete - Test Code 287
Ataxia
Hereditary Spastic Paraplegia
Endocrinology
Monogenic Diabetes (MODY) 5-Gene Evaluation - Test Code
885
Nephrology
Complete PKD Evaluation - Test Code 761