HumanaCommercial Clinical Policy

Genetic Testing for Diagnosis of Inherited Conditions Form

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Genetic Testing for Diagnosis of Inherited Conditions

Notes: Consult the member’s individual certificate for exclusions or specific definitions of medical necessity. The presence of state mandates or specific genetic test criteria for different conditions must be checked before proceeding with the coverage determination.

Indications

(568028) Is the genetic testing being performed to diagnose a condition that is not explicitly excluded in the coverage limitations? 
(568029) Is the genetic testing mandated by the state, overriding this medical coverage policy? 
(568030) Does the genetic testing meet disease- or gene-specific criteria as provided in the medical coverage policy document for the specific condition? 

Contraindications

(568031) Is the deletion/duplication information being submitted as an independent analysis while it was obtained as part of the sequencing procedure? 
(568032) Does the patient have an affected first-, second-, or third-degree relative with a negative genetic testing result for the associated condition? 
YesNoN/A
YesNoN/A
YesNoN/A

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Effective Date

12/14/2023

Last Reviewed

NA

Original Document

  Reference



Genetic Testing for Diagnosis of Inherited Conditions

Medical Coverage Policy

Effective Date: 12/14/2023
Revision Date: 12/14/2023
Review Date: 12/14/2023

Policy Number: HUM-0461-068
Page: 1 of 37

Change Summary: Updated Title, Description, Coverage Determination, Coverage Limitations,

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