Commercial | QUEST Integration | Medicare Advantage
Hawaii Medical Service Association (HMSA) partners with Avalon Healthcare Solutions (AHS) to streamline the management of genetic testing services. AHS and HMSA review genetic testing medical policies and services using the HRS-432 - Hawaii State Statute for Medical Necessity. For full medical necessity criteria, refer to to the genetic testing medical policies below.
For a listing of non-covered genetic testing codes, refer to Codes That Do Not Meet Payment Determination Criteria - Table I. Other relevant information may be found on HMSA’s Pathology and Lab - Claim Documentation Requirements page.
Precertification
Precertification is required for GTM. Please refer to the Genetic Testing Management (GTM) Utilization Review Matrix for a comprehensive listing of service codes which AHS manages on behalf of HMSA. All lines of business – commercial, Medicare, and QUEST Integration – are subject to AHS’ precertification review. Providers may submit precertification requests and/or questions 24/7 via AHS’:
Prior Authorization System (PAS) Portal
Phone: 844-227-5769
Fax: 813-751-3760
CURRENT GENETIC TESTING MEDICAL POLICIES
| Policy Name |
Notices |
Current Effective Date |
Policy # |
Additional Information |
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B
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C
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| Chromosomal Microarray |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
12/01/2025 |
AHS–M2033 |
Archived Policies |
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D
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E
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| Esophageal Pathology Testing |
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02/01/2026 |
AHS–M2171 |
Archived Policies |
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F
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| Fibromyalgia Testing |
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02/01/2026 |
AHS-M2177 |
Archived Policies |
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G
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| Gene Expression Profiling and Protein Biomarkers for Prostate Cancer |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
12/01/2025 |
AHS–M2166 |
Archived Policies |
| General Genetic Testing, Germline Disorders |
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02/01/2025 |
AHS-M2145 |
Archived Policies |
| General Genetic Testing, Somatic Disorders |
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08/01/2026 |
AHS–M2146 |
Archived Policies |
| Genetic Cancer Susceptibility Using Next Generation Sequencing |
60-day archival notice eff 02/01/2026 |
06/01/2023 |
AHS-M2066 |
Archived Policies |
| Genetic Markers for Assessing Risk of Cardiovascular Disease |
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12/01/2025 |
AHS–M2180 |
Archived Policies |
| Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma |
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06/01/2023 |
AHS–M2029 |
Archived Policies |
| Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma |
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02/01/2026 |
AHS-M2071 |
Archived Policies |
| Genetic Testing for Alpha- and Beta- Thalassemia |
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12/01/2025 |
AHS-M2131 |
Archived Policies |
Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers
Formerly: BRCA |
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02/01/2026 |
AHS–M2003 |
Archived Policies |
| Genetic Testing for CHARGE Syndrome |
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08/01/2026 |
AHS–M2070 |
Archived Policies |
| Genetic Testing for Connective Tissue Disorders |
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02/01/2026 |
AHS–M2144 |
Archived Policies |
| Genetic Testing for Cystic Fibrosis |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
12/01/2025 |
AHS-M2017 |
Archived Policies |
| Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
12/01/2025 |
AHS-M2072 |
Archived Policies |
| Genetic Testing for Duchenne, Becker, Facioscapulohumeral, and Limb-Girdle Muscular Dystrophies |
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06/01/2023 |
AHS-M2074 |
Archived Policies |
| Genetic Testing for Epilepsy |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
02/01/2026 |
AHS-M2075 |
Archived Policies |
| Genetic Testing for Familial Alzheimer Disease |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
12/01/2025 |
AHS-M2038 |
Archived Policies |
| Genetic Testing for Familial Cutaneous Malignant Melanoma |
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06/01/2023 |
AHS-M2037 |
Archived Policies |
| Genetic Testing for Familial Hypercholesterolemia |
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12/01/2025 |
AHS-M2137 |
Archived Policies |
| Genetic Testing for Fanconi Anemia |
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08/01/2026 |
AHS-M2077 |
Archived Policies |
| Genetic Testing for FMR1 Mutations |
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08/01/2026 |
AHS-M2028 |
Archived Policies |
| Genetic Testing for Germline Mutations of the RET Proto-Oncogene |
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06/01/2023 |
AHS-M2078 |
Archived Policies |
| Genetic Testing for Hereditary Hearing Loss |
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12/01/2025 |
AHS-G2148 |
Archived Policies |
| Genetic Testing for Hereditary Hemochromatosis |
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08/01/2026 |
AHS-M2012 |
Archived Policies |
| Genetic Testing for Hereditary Pancreatitis |
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12/01/2025 |
AHS-M2079 |
Archived Policies |
| Genetic Testing for Inherited Cardiomyopathies and Channelopathies |
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08/01/2026 |
AHS-M2025 |
Archived Policies |
| Genetic Testing for Lactase Insufficiency |
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12/01/2025 |
AHS-M2080 |
Archived Policies |
| Genetic Testing for Li-Fraumeni Syndrome |
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12/01/2025 |
AHS-M2081 |
Archived Policies |
| Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment |
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08/01/2026 |
AHS-M2082 |
Archived Policies |
| Genetic Testing for Mental Health Disorders |
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06/01/2023 |
AHS-M2084 |
Archived Policies |
| Genetic Testing for Neurodegenerative Disorders |
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02/01/2026 |
AHS–M2167 |
Archived Policies |
| Genetic Testing for Neurofibromatosis and Related Disorders |
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12/01/2025 |
AHS-M2134 |
Archived Policies |
| Genetic Testing for Ophthalmologic Conditions |
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12/01/2025 |
AHS-M2083 |
Archived Policies |
| Genetic Testing for Polyposis Syndrome |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
02/01/2026 |
AHS-M2024 |
Archived Policies |
| Genetic Testing for PTEN Hamartoma Tumor Syndrome |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
12/01/2025 |
AHS-M2087 |
Archived Policies |
| Genetic Testing for Rett Syndrome |
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08/01/2026 |
AHS-M2088 |
Archived Policies |
| Genetic Testing of CADASIL Syndrome |
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08/01/2026 |
AHS-M2069 |
Archived Policies |
| Genetic Testing of Mitochondrial Disorders |
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08/01/2026 |
AHS-M2085 |
Archived Policies |
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Genome and Exome Sequencing
Formerly: Whole Genome and Whole Exome Sequencing
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60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
12/01/2025 |
AHS-M2032
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Archived Policies |
| Genomic Testing for Hematopoietic Neoplasms |
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02/01/2026 |
AHS-M2182 |
Archived Policies |
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H
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I
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J
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K
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L
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| Laboratory Procedures Reimbursement Policy |
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03/01/2025 |
AHS-R2162 |
Archived Policies |
| Liquid Biopsy |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
02/01/2026 |
AHS-G2054 |
Archived Policies |
| Lynch Syndrome |
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02/01/2026 |
AHS-M2004 |
Archived Policies |
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M
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| Microsatellite Instability and Tumor Mutational Burden Testing |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
08/01/2026 |
AHS-M2178 |
Archived Policies |
| Minimal Residual Disease (MRD) |
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08/01/2026 |
AHS-M2175 |
Archived Policies |
| Molecular Analysis for Gliomas |
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02/01/2026 |
AHS–M2139 |
Archived Policies |
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Molecular Diagnostics for Breast Cancer Prognosis
Formerly: Molecular Expression Testing for Breast Cancer Prognosis
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02/01/2026 |
AHS-M2020 |
Archived Policies |
| Molecular Markers in Fine Needle Aspirates of the Thyroid |
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02/01/2026 |
AHS-M2108 |
Archived Policies |
| Molecular Profiling for Cancers of Unknown Primary Origin |
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12/01/2025 |
AHS-M2065 |
Archived Policies |
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Molecular Testing for Pulmonary Disease
Formerly: Molecular Testing for Pulmonary Specimens
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02/01/2026 |
AHS–M2160 |
Archived Policies |
| Multigene Expression Assay for Predicting Colon Cancer Recurrence |
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06/01/2023 |
AHS-M2111 |
Archived Policies |
| Mutation Analysis in Myeloproliferative Neoplasms |
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02/01/2026 |
AHS-M2101 |
Archived Policies |
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N
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O
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P
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| Pancreatic Cancer Risk Testing Using Pancreatitis Cyst Fluid |
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06/01/2023 |
AHS-M2114 |
Archived Policies |
| Pharmacogenetic Testing |
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02/01/2026 |
AHS-M2021 |
Archived Policies |
| Pre-Implantation Genetic Testing |
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02/01/2026 |
AHS-M2039 |
Archived Policies |
| Prenatal Screening (Genetic) |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
02/01/2026 |
AHS-M2179 |
Archived Policies |
| Prenatal Testing for Fetal Aneuploidy |
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08/01/2026 |
AHS-G2055 |
Archived Policies |
| Proteogenomic Testing of Individuals with Cancer |
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08/01/2026 |
AHS-M2168 |
Archived Policies |
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Q
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R
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| Red Blood Cell Molecular Testing |
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12/01/2025 |
AHS-M2170 |
Archived Policies |
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S
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T
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| Testing for Alpha-1 Antitrypsin Deficiency |
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02/01/2026 |
AHS-M2068 |
Archived Policies |
| Testing for Autism Spectrum Disorder and Developmental Delay |
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06/01/2023 |
AHS-M2176 |
Archived Policies |
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Testing for Colorectal Cancer Management
Formerly: KRAS NRAS BRAF Mutation Analysis in Colorectal Cancer
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60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
12/01/2025 |
AHS-M2026
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Archived Policies |
| Testing for Targeted Therapy of Non-Small-Cell Lung Cancer |
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12/01/2025 |
AHS-M2030 |
Archived Policies |
| Testing of Homocysteine Metabolism-Related Conditions |
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08/01/2026 |
AHS-M2141 |
Archived Policies |
| Therapeutic Drug Monitoring for 5-Flurouracil |
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02/01/2025 |
AHS-M2067 |
Archived Policies |
| Transplant Rejection Testing |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
02/01/2026 |
AHS-M2091 |
Archived Policies |
|
U
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| Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer |
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02/01/2026 |
AHS-M2126 |
Archived Policies |
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V
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| Venous and Arterial Thrombosis Risk Testing |
60-day provider notice 11/01/2026-12/31/2026 [PDF], in effect 01/01/2027 |
02/01/2026 |
AHS-M2041 |
Archived Policies |
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W
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X
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Y
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Z
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ARCHIVED GTM POLICIES
Unless otherwise noted, archived policies are inactive. Since archived policies are not updated, these policies will no longer be used when reviewing requests for coverage and these services will no longer require prior authorization, unless noted.
| Archived Policy Title |
Policy Versions |
Archived as of: |
| BCR-ABL 1 Testing - AHS-M2027 |
Archived Policies |
02/01/2025 |
| Genetic Testing for Acute Myeloid Leukemia - AHS-M2062 |
Archived Policies |
02/01/2025 |
| Date |
Nature of Revision |
| 11/09/2026 |
60-Day Notices have been posted for the following policies, eff. 01/01/2027:
- Chromosomal Microarray and Low-pass Whole Genome Sequencing
- Gene Expression Profiling and Protein Biomarkers for Prostate Cancer
- Genetic Testing for Cystic Fibrosis
- Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies
- Genetic Testing for Epilepsy
- Genetic Testing for Familial Alzheimer Disease
- Genetic Testing for Polyposis Syndromes
- Genetic Testing for PTEN Hamartoma Tumor Syndrome
- Genome and Exome Sequencing
- Liquid Biopsy
- Microsatellite Instability and Tumor Mutational Burden Testing
- Prenatal Screening (Genetic)
- Testing for Colorectal Cancer Management
- Transplant Rejection Testing
- Venous and Arterial Thrombosis Risk Testing
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| 11/09/2026 |
The following policies, eff. 08/01/2026 have been posted:
- General Genetic Testing, Somatic Disorders
- Genetic Testing for CHARGE Syndrome
- Genetic Testing for Fanconi Anemia
- Genetic Testing for FMR1 Mutations
- Genetic Testing for Hereditary Hemochromatosis
- Genetic Testing for Inherited Cardiomyopathies and Channelopathies
- Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment
- Genetic Testing for Rett Syndrome
- Genetic Testing of CADASIL Syndrome
- Genetic Testing of Mitochondrial Disorders
- Microsatellite Instability and Tumor Mutational Burden Testing
- Minimal Residual Disease (MRD)
- Prenatal Testing for Fetal Aneuploidy
- Proteogenomic Testing of Individuals with Cancer
- Testing of Homocysteine Metabolism-Related Conditions
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| 09/28/2026 |
Migrated to new platform |