Letters of Medical Necessity

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

CNS Autoantibodies
Complete Paraneoplastic Evaluation - Test Code 467
Paraneoplastic Neurological Syndromes, Initial Assessment - Test Code 4500 

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
Charcot-Marie-Tooth Disease (CMT) - Comprehensive Evaluation - Test Code 4001 
CMT Advanced Evaluation - Initial Genetic Assessment - Test Code 4010
SensoriMotor Neuropathy Profile - Complete - Test Code 287


Ataxia, Comprehensive Evaluation - Test Code 6930
Ataxia, Complete Dominant Evaluation - Test Code 6900
Ataxia, Complete Recessive Evaluation - Test Code 6910
Ataxia, Common Repeat Expansion Evaluation - Test Code 6901
Ataxia, Supplemental Recessive Evaluation - Test Code 6911

Hereditary Spastic Paraplegia

HSP, Comprehensive Evaluation - Test Code 6630
HSP, Common Sporadic Evaluation - Test Code 6601
HSP, Complete Dominant Evaluation - Test Code 6610
HSP, Common Dominant Evaluation - Test Code 6611

Monogenic Diabetes (MODY) 5-Gene Evaluation - Test Code 885

Complete PKD Evaluation - Test Code 761

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Athena Diagnostics is a leader in diagnostic testing for neurological diseases and offers innovative tests for Alzheimer's disease, muscular dystrophy and other neuromuscular and developmental disorders.

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