Reminder: Genetic Testing Coverage and Lab Options
Date: 01/13/26
Sunshine Health remains committed to ensuring children get the genetic testing they need when they need it. We want to clarify our approach to genetic testing to ensure that providers have the information they need to deliver timely, high-quality care.
Our policies align with the American Academy of Pediatrics recommendations and guidelines for whole exome sequencing (WES) and whole genome sequencing (WGS) testing for pediatric patients who have a diagnosis of global developmental delay/intellectual disability, but is not inclusive of children with a diagnosis of Autism Spectrum Disorder (ASD) alone.
As a reminder, when medically necessary criteria are met, testing must be completed by in-network laboratories for non-emergent cases. For pediatric patients in an ICU setting, rapid genetic testing is approved regardless of whether the lab is in-network or out-of-network, and does not require prior authorization. This ensures that critically ill children receive timely diagnostic information without delays related to network status.
Please remember that prior authorization is required for all other genetic testing beforehand to avoid denied claims. We understand it can sometimes be advantageous for providers to collect specimens before authorization is received, but they should not send them for processing until it is received.
Sunshine Health offers several quality in-network labs for genetic testing. We are also expanding options to add Variantyx to our network for WGS and rapid WES.
Below is a summary of available lab options and turnaround times (TAT). All offer WES; Fulgent, Baylor and Variantyx offer Rapid WES and WGS. All turnaround times are published by the respective labs.
Lab/Link | Phone | WES TAT | Rapid WES TAT | WGS TAT |
|---|---|---|---|---|
6-8 weeks | N/A | N/A | ||
5-7 weeks | 2-5 DAYS | 3-5 weeks | ||
4-6 weeks | N/A | N/A | ||
3 weeks | 5-6 days | 3 weeks | ||
4-6 weeks | 1 week | 4-6 weeks |
Questions?
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- Provider Support: Finding the Right Contact
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