HumanaCommercial Clinical Policy

Genetic Testing for Muscular Dystrophy and Spinal Muscular Atrophy Form


Genetic Testing for Muscular Dystrophy and SMA

Notes: Please refer to the member's individual certificate for the specific definition of medical necessity and exclusions for genetic testing coverage.

Indications

(395068) Does the state mandate genetic testing for muscular dystrophy or SMA for the patient? 
(395069) Does the patient's individual certificate exclude genetic testing for muscular dystrophy or SMA? 
(395070) Are gene-specific criteria not available for the patient's condition, requiring the use of General Criteria for Genetic and Pharmacogenomics Tests? 

Contraindications

(395071) Is the genetic test for muscular dystrophy or SMA not listed in the policy's eligibility criteria? 
(395072) Is the patient unaffected with the condition and an affected first-, second-, or third-degree relative available for genetic testing? 
YesNoN/A
YesNoN/A

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Effective Date

05/25/2023

Last Reviewed

NA

Original Document

  Reference



Genetic Testing for Muscular Dystrophy and Spinal Muscular Atrophy

Medical Coverage Policy

Effective Date: 05/25/2023

Revision Date: 05/25/2023

Review Date: 05/25/2023

Policy Number: HUM-0538-018

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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