Genetic testing

Closeup of a female provider looking through a microscope in a lab

Genetic testing policy update

Dean Health Plan updated medical policies for Genetic Testing in June 2017.

Here are a few things 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 DeanCare Gold do not have genetic testing authorization requirements.
  • ASO members are excluded from the 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
 
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.
 
  • 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. 
If you have any questions contact our Customer Care Center at (800) 279-1301 with any additional questions.
 

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

Medical policyMedical policy #Policy typeAuthorization requiredGenetic counseling required
 (ASO members excluded)
Whole exome and whole genome sequencingMP9548GeneralXX
General genetic testing policyMP9012GeneralSome 
Hereditary cardiac disease and arrhythmiasMP9472CardiacXX
ThrombophiliaMP9473General  
Reproductive carrier screening and prenatal diagnosisMP9477Maternal-FetalSome 
BRCA1 and BRCA2MP9478CancerXX
Pharmacogenetic testingMP9479GeneralX 
PolyposisMP9482CancerXX
Multiple endocrine neoplasia, type 1 & 2MP9483CancerXX
Diffuse castric cancer – CDH1 geneMP9484CancerXX
Somatic tumor markers, gene expression assays for hematology/oncology indicationsMP9486General  
Lynch SyndromeMP9487CancerXX
Cowden Syndrome – PTEN genesMP9488CancerXX
Chromosomal microarray analysisMP9491General  
Neurologic disordersMP9497GeneralXX
Marfan SyndromeMP9506GeneralXX
Stickler SyndromeMP9504GeneralXX
Maturity onset of the young (MODY) sequencing panelMP9507GeneralXX
Hereditary cancer susceptibilityMP9521Cancer  
Ehlers-Danlos SyndromeMP9505GeneralXX
Hereditary hemorrhagic telangiectasia (HHT)MP9524GeneralXX
HypercholesterolemiaMP9525GeneralXX
Birt Hogg Dube SyndromeMP9527GeneralXX
Focal segmental glomerular sclerosisMP9543GeneralXX
Covered genetic testing that does not require a prior authorization.
All of the above numbered medical policies meet the medical necessity criteria component. See our full list of genetic testing policies.