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 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

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
HSP, Complete Recessive Evaluation – Test Code 6620



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

Nephrology
Complete PKD Evaluation - Test Code 761