Persons who display exercise-, catecholamine-, or emotion-induced PVT or ventricular fibrillation, occurring in a structurally normal heart.Persons with a first-degree relative (i.e., parent, full-sibling, child) with a defined CPVT mutation ( Note: Test for known familial mutation) or.Catecholaminergic polymorphic ventricular tachycardia (CPVT) :Īetna considers genetic testing for CPVT medically necessary for the following indications:.Symptomatic individuals who have a family history consistent with an autosomal dominant pattern of inheritance of this condition (clinical signs and symptoms of CADASIL include stroke, cognitive defects and/or dementia, migraine, and psychiatric disturbances).Īetna considers CADASIL genetic testing experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established.Pre-symptomatic individuals where there is a family history consistent with an autosomal dominant pattern of inheritance and there is a known mutation in an affected member of the family or.Full sequence APC genetic testing is considered medically necessary only when it is not possible to determine the family mutation first.Īetna considers APC genetic testing experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established.Īetna considers DNA testing for CADASIL medically necessary for either of the following indications: The specific APC mutation should be identified in the affected first-degree relative with FAP prior to testing the member, if feasible. Members with first-degree relatives (i.e., siblings, parents, and offspring) diagnosed with familial adenomatous polyposis (FAP) or with a documented APC mutation.Members with a desmoid tumor, hepatoblastoma, or cribriform-morular variant of papillary thyroid cancer or.Members with greater than 10 colonic polyps or.See Appendix for List 1: Suspected Diagnoses.Īetna considers adenomatous polyposis coli (APC) genetic testing medically necessary for either of the following indications: After history, physical examination, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain, and one of the following diagnoses is suspected (this list is not all-inclusive) and.The result of the test will directly impact the treatment being delivered to the member and.The member displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic) and.This Clinical Policy Bulletin addresses genetic testing.Īetna considers genetic testing medically necessary to establish a molecular diagnosis of an inheritable disease when all of the following are met: Number: 0140 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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