Medical Policy Updates: Genetic Counseling Required Prior to Genetic Testing

Medical Policy Updates: Genetic Counseling Required Prior to Genetic Testing

5/11/2017

Effective July 1, 2017, an update to the policy criteria will be implemented to require documented genetic counseling for members prior to receiving genetic testing for the following medical policies as required for CAM – 166 General Genetic Testing, Germline Disorders:
 
  • CAM 20402 – Genetic Testing for Hereditary BRCA 1/BRCA 2 testing
  • CAM 168 – Familial Adenomatous Polyposis (FAP) and MUYTH-Associated Polyposis (MAP)
  • CAM 169 –  Lynch Syndrome Testing
Genetic counseling for germline mutations is recommended after screening by providers for members who may be at risk for hereditary cancer syndromes. This recommendation is supported by many medical societies including, but not limited to, The US Preventative Services Task Force, The American College of Obstetrics and Gynecology, The American College of Medical Genetics and Genomics, and The National Society of Genetic Counselors.
 
Genetic counseling covers many aspects of the testing process for germline mutations. This should be represented by submission of informed consent for testing to occur, information on a cancer risk assessment based on the member’s personal and family medical history, and the implications of a positive of negative result on the member and their family members. Knowledge of germline mutations through genetic testing for those at risk can impact many healthcare decisions. Please be advised that the above information should be included in any provider request for BRCA 1 and 2, FAP and MAP or Lynch germline mutation testing.
 
For complete information on the changes to policy CAM 20402, CAM 168 and CAM 169, visit our Medical Policies page. You may also contact Provider Education by using the Provider Education Contact Form or by calling 803-264-4730
 
Sources:
  1. American College of Medical Genetics and Genomics. (2017). Policy statements. Retrieved May 9, 2017, from http://www.acmg.net/ACMG/Publications/Policy_Statements/ACMG/Publications/Policy_Statements.aspx?hkey=6b7572b3-d01c-42a5-b59e-c0593347751c
  2. American College of Obstetricians and Gynecologists. (2015). Hereditary cancer syndromes and risk assessment. Committee Opinion No. 634.. Obstet Gynecol 2015;125:1538–43
  3. Riley BD, Culver JO, Skrzynia C, et al.: Essential elements of genetic cancer risk assessment, counseling, and testing: updated recommendations of the National Society of Genetic Counselors. J Genet Couns 21 (2): 151-61, 2012
  4. U.S. Preventative Services Task Force. (2013). BRCA-related cancer: Risk assessment, genetic counseling, and genetic testing. Retrieved May 9, 2017, from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing

 


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