Carelon updated its clinical appropriateness guidelines to include whole-exome sequencing (WES) and whole-genome sequencing (WGS) for certain outpatient scenarios, potentially shifting payor coverage for genomic testing. The updates, effective last week, specify testing as medically necessary in defined postnatal and pediatric indications, while WGS is labeled not medically necessary in prenatal outpatient settings. The guideline change also ties eligibility to how testing is performed, including requiring use of a CLIA-certified laboratory accredited by CAP and requiring reports to ordering clinicians. Carelon’s approach covers scenarios such as prenatal conditions linked to genetic disorder characteristics, and postnatal cases with multiple anomalies where targeted panels are not appropriate. Industry feedback in the article highlighted the potential impact on access: expanding coverage for outpatient genome sequencing is described as a signal that payors increasingly value clinical actionability of comprehensive genomic testing.