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Coverage criteria policies

Direct-to-Consumer (DTC) Laboratory Testing

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for direct-to-consumer (DTC) laboratory testing.

Coverage

Direct-to-Consumer Laboratory Testing is generally not covered per your plan documents since it is an over the counter service.

Indications that are not covered

The following are examples non-covered home test kits that are mailed to a laboratory for evaluation. This is not an all-inclusive list.

  1. Allergy testing for common home allergens
  2. Antioxidant levels (urine lipid peroxide)
  3. Male and female hormone testing
  4. High sensitivity CRP, to screen for heart disease
  5. Hepatitis C, to determine hepatitis infection
  6. HIV-1 antibody, for determining HIV infection
  7. Microalbumin, to screen for kidney disease
  8. Hair, urine, and salivary testing for any reason
  9. Performance and stress hormone levels of testosterone, DHEA and cortisol
  10. Melatonin levels to assess sleep
  11. TSH for thyroid function
  12. Antibodies involved in Celiac disease
  13. Paternity testing, sperm counts
  14. hCG, to screen for pregnancy
  15. Blood typing
  16. Genetic testing
  17. Cholesterol, Hemoglobin
  18. Alcohol , nicotine, or drug screening tests

Definitions

Direct to Consumer (DTC) testing is defined as laboratory testing that is received with results given and reported without provider input.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 11/22/2010 - Date of origin
  • 12/04/2017 - Effective date
Review date
  • 12/2017

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