Genetic testing for DMD gene variants may be considered medically necessary under the following conditions:
In a male with signs and symptoms of a dystrophinopathy in order to confirm the diagnosis and direct treatment.
For at-risk female relatives (see Policy Guidelines and Benefit Application sections):
To confirm or exclude the need for cardiac surveillance.
For preconception testing to determine the likelihood of an affected offspring in a woman considering a pregnancy.
For at-risk male offspring (see Policy Guidelines and Benefit Application sections):
To confirm or exclude the need for medical and cardiac surveillance.
Genetic testing for DMD gene variants is considered investigational in all other situations.
