Revised April 20, 2021
Genetic counseling covers many aspects including understanding the natural history, disease risks, and mode of transmission of a genetic disorder. It also allows for consent for genetic testing, when appropriate, along with options for risk management and planning. Certain genetic testing services may require documented genetic counseling prior to coverage. We recommend viewing the medical policy of the specific genetic test and all other requirements for coverage prior to rendering genetic tests.
Below is an example of the coverage criteria for CAM 169 – Lynch Syndrome Testing showing genetic counseling is medically necessary:
- Genetic counseling is considered MEDICALLY NECESSARY for individuals undergoing Lynch Syndrome (LS) testing. Genetic counseling is required prior to undergoing testing for LS testing.
- Testing for a known deleterious LS mutation is considered MEDICALLY NECESSARY for individuals when a familial mutation is identified in affected family member. Risk assessment should be limited to testing for the known familial mutation and not for other mutations.
- If no known LS pathogenic variant in family, germline multi-gene testing OR tumor testing with immunohistochemistry (IHC) and/or microsatellite instability (MSI) is considered MEDICALLY NECESSARY in individuals meeting criteria in Note 1. For expanded panel testing, please refer to policy AHS-M2109 Molecular Panel Testing of Cancers to Identify Targeted Therapy.
Visit the Medical Policies pages of www.BlueChoiceSC.com to review the criteria for the genetic test to be rendered to determine if genetic counseling is required.
If you have any questions about this bulletin, contact Provider Education using the Provider Education Contact Form.