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HealthPartners

Coverage criteria policies

Genetic testing

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is required for genetic testing unless otherwise noted in one of the policies listed below.

Coverage

  • For genetic testing related to cancer management, see the Genetic Testing: Molecular Profiling for Cancer Management coverage policy.
  • For genetic testing related to cancer susceptibility, see the Genetic Testing for Cancer Predisposition coverage policy.
  • For genetic testing related to cardiac and cardiovascular disease or coagulation disorders, see the Genetic Testing for Arrhythmias and Cardiomyopathies and/or the Genetic Testing: Coagulation Disorders and Cardiovascular Risk Assessments coverage policies.
  • For genetic testing related to connective tissue, skeletal, or integumentary disorders, see the Genetic Testing for Connective Tissue, Skeletal, and Integumentary Disorders coverage policy.
  • For genetic testing related to gastrointestinal disorders, see the Genetic Testing for Gastrointestinal Disorders coverage policy.
  • For genetic testing related to neurodegenerative or neuromuscular conditions, see the Genetic Testing for Neurodegenerative and Neuromuscular Disorders coverage policy.
  • For genetic testing related to neurodevelopmental disorders, seizure disorders, and/or multiple congenital anomalies, see the Genetic Testing for Neurodevelopmental Disorders, Epilepsy and Seizure Disorders, and Multiple Congenital Anomalies coverage policy.
  • For genetic testing related to reproductive planning and prenatal diagnosis, see the Genetic Testing: Carrier Screening, Prenatal Screening, Prenatal Diagnosis, and Infertility Evaluation coverage policy.
  • For pharmacogenetic testing, see the Genetic Testing: Pharmacogenetics coverage policy.

Genetic testing for any indication other than described in specific coverage policies listed above is subject to a review for medical necessity, based on current clinical literature and expert recommendations.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 07/27/2015 - Date of origin
  • 11/01/2017 - Effective date
Review date
  • 07/2017
Revision date
  • 11/01/2017

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