Genetic Testing, Providers. Dean Health Plan

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Genetic Testing

Effective June 5 2017, Dean Health Plan will have updated medical policies for Genetic Testing. Key notes to consider:

  • Current Medical Policy MP9012 serves as the general policy for genetic testing and will provide links to specific genetic tests.
  • If a medical policy does not refer to a specific genetic test, applicable evidenced based guidelines and a prior authorization will be required.
  • Authorization, genetic counseling and medical necessity requirements may be test specific, as identified within each medical policy.
  • Medical necessity criteria will be applied to Commercial HMO, POS, PPO, BadgerCare and ASO members. Dean Advantage and DeanGold do not have genetic testing authorization requirements.
  • ASO members are excluded from the Genetic Counseling requirement.

 

The chart below identifies NEW medical policy components, which may vary by test. See individual policy for details:

Medical Policy Medical Policy # Policy Type Authorization Required Genetic Counseling Required
(ASO members excluded)
Medical Necessity Criteria

General Genetic Testing Policy

MP9012 General Some   X

Hereditary Cardiac Disease & Arrhythmias

MP9472 Cardiac X X X

Thrombophilia

MP9473 General     X

Reproductive Carrier Screening & Prenatal Diagnosis

MP9477 Maternal-Fetal Some   X

BRCA1 and BRCA2

MP9478 Cancer X X X

Pharmacogenetic Testing

MP9479 General X   X

Peutz-Jeghers Syndrome

MP9480 Cancer X X X

Hearing Loss & Usher Syndrome

MP9481 General X   X

Polyposis

MP9482 Cancer X X X

Multiple Endocrine Neoplasia, Type 1 & 2

MP9483 Cancer X X X

Diffuse Gastric Cancer – CDH1 Gene

MP9484 Cancer X X X

Li-Fraumeni Syndrome – TP53 Gene

MP9485 Cancer X X X

Somatic Tumor Markers, Gene   Expression Assays for Hematology/Oncology Indications

MP9486 General     X

Lynch Syndrome

MP9487 Cancer X X X

Cowden Syndrome – PTEN Gene

MP9488 Cancer X X X

Huntington Disease

MP9490 General X X X

Chromosomal Microarray Analysis

MP9491 General     X
Covered Genetic Testing that does not Require a Prior Authorization

View a full list of medical policies related to genetic testing

Genetic testing - prior authorization

  • If you are a Dean Health Plan Provider Portal user, submit prior authorization requests via the provider portal
  • If you do not have access to submit prior authorization via the provider portal, fax the Genetic Testing prior authorization form to the number indicated on the form

Genetic counseling requirement

Certain tests require pre-test and post- test genetic counseling. Prior authorization is not required for referrals to a genetic counselor. **As a reminder, ASO members are excluded from this requirement

Genetic counseling resources

Dean Health Plan in-network providers who employ genetic counselors may continue to use a current process that may be in place to comply with Dean Health Plan’s updated genetics testing medical policies where genetic counseling is required.

Dean Health Plan recognizes the limited accessibility of genetic counselors. We have partnered with InformedDNA (IDNA) to provide telephonic genetic counseling services for Dean Health Plan members. Our goal is to improve member satisfaction and ease the burden for our providers. If no genetic counselors are available within your organization or there is an access issue, Dean Health Plan’s member may be referred to InformedDNA (IDNA). Use the IDNA Cancer Genetic Counseling Referral Form or the Cardiac Genetic Counseling Referral Form to refer to IDNA.

We’re here to help

If you have any questions contact our Customer Care Center at (800) 279-1301 with any additional questions.

 

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