Description

The methylene tetrahydrofolate reductase (MTHFR) enzyme is encoded by the MTHFR gene. This enzyme plays a role in processing amino acids (the building blocks of proteins) which is important for a chemical reaction involving forms of the vitamin folate and is required for the multistep process that converts the amino acid homocysteine to another amino acid, methionine. The body uses methionine to make proteins and other important compounds.

Variations in the MTHFR gene have been studied as risk factors for numerous conditions, including behavioral disorders, cardiovascular disease, thrombophilia, stroke, hypertension, pharmacological management or risk testing and pregnancy-related complications; however, its role remains unclear.

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Genetic Testing for Methylene Tetrahydrofolate Reductase

Effective Date: 03/23/2023
Revision Date: 03/23/2023
Review Date: 03/23/2023
Policy Number: HUM-0543-008
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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.

Humana recognizes that the field of genetic testing is rapidly changing and that other tests may become available.

Coverage Determination

Any state mandates for genetic testing for MTHFR take precedence over this medical coverage policy.

Genetic testing may be excluded by certificate. Please consult the member’s individual certificate regarding Plan coverage.

Humana members may NOT be eligible under the Plan for genetic testing for MTHFR (81291), individually or as part of a panel. This is considered experimental/ investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Additional information about MTHFR gene testing may be found from the following websites:

• Background
• National Library of Medicine

Medical Alternatives

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Humana may offer a disease management program for this condition. The member may call the number on his/her identification card to ask about our programs to help manage his/her care.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.