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General Approach to Evaluating the Utility of Genetic Panels

Genetic panels that use next-generation sequencing or chromosomal microarray analysis, and are classified in one of the categories below, may be considered medically necessary when all criteria are met for each category, as outlined in the Rationale section:•         Panels for hereditary or genetic conditions

o    Diagnostic testing of an individual’s germline to benefit the individual

o    Testing of an asymptomatic individual to determine future risk of disease

•         Cancer panels

o    Testing of an asymptomatic individual to determine future risk of cancer

o    Testing cancer cells from an individual to benefit the individual by identifying targeted treatment

•         Reproductive panels

o    Preconception testing – Carrier testing of the parent(s)

o    Prenatal testing

§  Carrier testing of the parent(s)

§  In utero testing of a fetus, including testing for aneuploidy or familial variants

o    Preimplantation genetic testing.

Genetic panels that use next-generation sequencing or chromosomal microarray that do not meet the criteria for a specific category are considered investigational.

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