Carelon Medical Benefits Management (MBM) has announced updates to its Genetic Testing Program policies that will take effect on August 1, 2025. Under the new policy, the Date of Service (DOS) for genetic testing services will be defined as the sample or collection date for all lines of business, aligning with the CMS Medicare Laboratory Date of Service Policy. For archival samples—those stored for future use, analysis, or reference—the DOS will be considered the date the sample was collected or retrieved.
Providers can review the full announcement by visiting the Carelon Provider Connections page at this link. Once there, scroll to the Genetic Testing Program section and click on the article titled “Reminder: Genetic Testing Program updates coming soon.”
Laboratory providers who wish to request an exception to these policy changes may contact the Carelon MBM Genetic Testing Team by emailing DL-GeneticTestingSolution@carelon.com.
For Quadax clients, if this policy update requires a change in how service dates are handled, please consult your Quadax representative to begin planning. This may involve modifications to your billing interface with Quadax.
