Genetic testing is evolving rapidly, with over 175,000 tests available and 10 new ones introduced daily. Yet the market lacks alignment in coding, clinical evidence, and reimbursement, leading to:

  • Gaps in provider knowledge and test interpretation
  • Inconsistent coverage and authorization practices
  • High variability in test quality, cost, and utility
  • Lack of coding specificity

Managing this complexity requires more than coding logic—it demands diagnostic intelligence.

Diagnostic Intelligence

PGTM is a core pillar of Avalon’s Diagnostic Insights Platform—a comprehensive system integrating lab network design, utilization enforcement, routine and genetic testing, and claims intelligence.

By embedding PGTM into a broader diagnostic strategy, health plans gain a scalable, modular solution that continuously delivers value, from point-of-care decisions to enterprise-level performance.