HumanaCommercial Clinical Policy

Genetic Testing for Hereditary Ataxias Form

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Genetic Testing for Hereditary Ataxias

Notes: Review the member’s individual certificate for possible exclusions and consult state mandates for any additional requirements.

Indications

(768636) Is the patient's genetic testing for hereditary ataxias being conducted for either CANVAS (RFC1 Gene), FRDA (FXN Gene), or Spinocerebellar Ataxia (SCA) (ATXN1, ATXN2, ATXN3, CACNA1A, ATXN7, and ATN1 Genes)? 
(768637) Does the patient's genetic testing for hereditary ataxias meet all disease- or gene-specific criteria provided in the medical coverage policy document? 
(768638) Does the patient's multigene panel test include ALL genes that meet the disease- or gene-specific criteria? 

Contraindications

(768639) Is the genetic test for CACNA1A full gene sequence analysis (eg, Genomic Unity CACNA1A analysis [0231U])? 
(768640) Is the genetic testing being performed to determine the risk in an unaffected individual? 
YesNoN/A
YesNoN/A

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Effective Date

06/22/2023

Last Reviewed

NA

Original Document

  Reference



Genetic Testing for Hereditary Ataxias

Medical Coverage Policy

Effective Date: 06/22/2023
Revision Date: 06/22/2023
Review Date: 06/22/2023
Policy Number: HUM-0522-020

Change Summary: Updated References

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

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