Genetic testing 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:
1. Testing of an affected (symptomatic) individual’s germline DNA to benefit the individual (excluding reproductive testing)
a. Diagnostic
b. Prognostic
c. Therapeutic
2. Testing cancer cells of an affected individual to benefit the individual
a. Diagnostic
b. Prognostic
c. Therapeutic
3. Testing an asymptomatic individual to determine future risk of disease.
Genetic testing that does not meet the criteria for a specific category is considered investigational or not medically necessary, according to the standard definitions used for these terms (see Policy Guidelines section).
