Genetic Testing for Connective Tissue, Skeletal, and Integumentary Disorders
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.
Prior authorization is required for genetic testing for connective tissue, skeletal, and integumentary disorders.
For prenatal diagnostic genetic testing, see the Genetic Testing: Carrier Screening, Prenatal Screening, Prenatal Diagnosis, and Infertility Evaluation coverage policy.
For genetic testing for multiple congenital anomalies, see the Genetic Testing for Neurodevelopmental Disorders, Epilepsy and Seizure Disorders, and Multiple Congenital Anomalies coverage policy.
Indications that are covered
Single-gene and multiple-gene analysis for these conditions is covered when criteria 1-3 listed below are met:
- Ehlers-Danlos syndrome (EDS), vascular type
- Epidermolysis bullosa/Kindler syndrome
- Hereditary hemorrhagic telangiectasia
- Inherited ichthyoses
- Legius syndrome
- Loeys-Dietz syndrome
- Marfan syndrome
- Neurofibromatosis, types 1 and 2
- Ocular albinism
- Osteogenesis imperfecta and/or dentinogenesis imperfecta
- Thoracic Aortic Aneurysm and Dissection (TAAD)
- The test is ordered by a board-certified cardiologist; dermatologist; neurologist; ophthalmologist; rheumatologist; or geneticist; a licensed, certified genetic counselor; or an advanced-practice nurse in cardiology; dermatology, neurology; ophthalmology, rheumatology, or genetics, and is expected to directly impact management of one of the above specific, clinically-suspected, connective tissue, skeletal, or integumentary disorders.
- The member has received genetic counseling with a board-certified genetic counselor or medical geneticist who is not affiliated with the commercial testing laboratory, if applicable.
- The member has a personal history consistent with the condition being evaluated or a first-degree blood relative has been diagnosed with the condition being evaluated.
Genetic testing for connective tissue, skeletal, and integumentary disorders other than those listed above is subject to a review for medical necessity, based on current clinical literature and expert recommendations, unless listed below as an indication that is not covered.
Indications that are not covered
- Genetic testing for connective tissue, skeletal, and integumentary disorders is not covered and is considered not medically necessary when test results will not directly impact the treatment or management of a condition because the testing is not expected to restore or maintain the member’s health, prevent deterioration of the member’s condition, nor prevent the reasonably likely onset of a health problem or detect an incipient problem.
- Repeat testing of a unique analyte using the identical method of analysis is not covered and is considered not medically necessary because it is not considered an appropriate frequency of care.
- Multiple-gene panels that include genes not associated with the specific condition under evaluation are not covered and are considered not medically necessary because they are not considered an appropriate type of service for the member’s condition.
- Single-gene and multiple-gene assays for the following conditions are considered experimental/investigational, because reliable evidence does not permit conclusions concerning safety, effectiveness, or effect on health outcomes, including, but not limited to:
- Anhidrotic ectodermal dysplasia
- Ehlers-Danlos syndrome, except as described above
- Familial partial lipodystrophy
- Isolated abdominal aortic aneurysm
- Hereditary multiple osteochondromas
- Mitral valve prolapse syndrome
- Peripheral pulmonary stenosis
- Pseudoxanthoma elasticum
First-degree relative is an individual’s parent, sibling, or child
Genetic refers to inherited traits or disorders, or those that result from acquired changes in genetic makeup.
Genetic Testing involves analysis of human genetic material (such as DNA or chromosomes) to identify whether a person has a particular inherited trait or disorder, or an acquired genetic change, or whether he or she carries a gene that could lead to a specific disease or condition.
If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.
Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK
Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1
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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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