Medical Policy Updates

Notification of Policy Revisions Effective November 22, 2011 (Posted August 16, 2011)

Medical Policy	Revision
Genetic Testing for Non-Malignant Inherited Disorders "Notification"	New policy implemented. Genetic testing for non-malignant inherited disorders may be considered medically necessary when the following criteria are met: The genetic disorder is associated with significant disability or has a lethal natural history; AND The risk of the significant disability or lethality from the genetic disorder cannot be determined through other diagnostic testing, AND A specific mutation, or set of mutations, has been proven valid in the scientific literature to be reliably associated with the disease; AND The results of the genetic test could impact the medical management of the individual being tested; AND The genetic test will likely result in an anticipated improvement in net health outcomes for the individual being tested; (i.e. the disease is treatable or preventable) AND Testing is accompanied by genetic counseling AND Proper informed consent is obtained. Genetic testing for individuals not meeting the above criteria is considered not medically necessary. Whole genome sequencing in which an individual's entire DNA is sequenced is considered investigational. Use of home testing kits is considered investigational. Notice given 8/16/11 for effective date 11/22/11.
Genetic Testing for Cutaneous Malignant Melanoma "Notification"	New policy implemented. Genetic testing for mutations associated with hereditary cutaneous malignant melanoma or associated with susceptibility to cutaneous malignant melanoma is considered investigational. Medical Director review 8/2011. Notice given 8/16/11 for effective date 11/22/11.

Medical Policy

Revision

Genetic Testing for Non-Malignant Inherited Disorders "Notification"

New policy implemented. Genetic testing for non-malignant inherited disorders may be considered medically necessary when the following criteria are met: The genetic disorder is associated with significant disability or has a lethal natural history; AND The risk of the significant disability or lethality from the genetic disorder cannot be determined through other diagnostic testing, AND A specific mutation, or set of mutations, has been proven valid in the scientific literature to be reliably associated with the disease; AND The results of the genetic test could impact the medical management of the individual being tested; AND The genetic test will likely result in an anticipated improvement in net health outcomes for the individual being tested; (i.e. the disease is treatable or preventable) AND Testing is accompanied by genetic counseling AND Proper informed consent is obtained. Genetic testing for individuals not meeting the above criteria is considered not medically necessary. Whole genome sequencing in which an individual's entire DNA is sequenced is considered investigational. Use of home testing kits is considered investigational. Notice given 8/16/11 for effective date 11/22/11.

Genetic Testing for Cutaneous Malignant Melanoma "Notification"

New policy implemented. Genetic testing for mutations associated with hereditary cutaneous malignant melanoma or associated with susceptibility to cutaneous malignant melanoma is considered investigational. Medical Director review 8/2011. Notice given 8/16/11 for effective date 11/22/11.