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
Letter

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

Epilepsy
Epilepsy Advanced Sequencing Evaluation - Test Code 5000
Epilepsy Advanced Sequencing Evaluation - Generalized, Absence, Focal, and Myoclonic Epilepsies - Test Code 5001
Epilepsy Advanced Sequencing Evaluation - Epileptic Encephalopathies - Test Code 5002
Epilepsy Advanced Sequencing Evaluation - Neuronal Migration Disorders - Test Code 5003
Epilepsy Advanced Sequencing Evaluation - Epilepsy in X-Linked Intellectual Disability - Test Code 5004
Epilepsy Advanced Sequencing Evaluation - Neuronal Ceroid Lipofuscinosis - Test Code 5005
Epilepsy Advanced Sequencing Evaluation - Epilepsy with Migraine - Test Code 5006
Epilepsy Advanced Sequencing Evaluation - Syndromic Disorders - Test Code 5007
Epilepsy Advanced Sequencing Evaluation - Infantile Spasms - Test Code 5008
Complete Tuberous Sclerosis Evaluation - Test Code 556‚Äč
SCN1A Evaluation - Test Code 573
Autoimmune Epilepsy Evaluation - Test Code 5100

Exome Sequencing
Neurome Neurological Exome - Test Codes 1500, 1501

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
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

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

Nephrology
Complete PKD Evaluation - Test Code 761