Information

Title Genetic Testing Medical Policies: Avalon

Content

Commercial | QUEST Integration | Medicare Advantage

Hawaii Medical Service Association (HMSA) partners with Avalon Healthcare Solutions (AHS) to streamline the management of genetic testing services. AHS and HMSA review genetic testing medical policies and services using the HRS-432 - Hawaii State Statute for Medical Necessity. For full medical necessity criteria, refer to to the genetic testing medical policies below.

For a listing of non-covered genetic testing codes, refer to Codes That Do Not Meet Payment Determination Criteria - Table I. Other relevant information may be found on HMSA’s Pathology and Lab - Claim Documentation Requirements page.

Precertification

Precertification is required for GTM. Please refer to the Genetic Testing Management (GTM) Utilization Review Matrix for a comprehensive listing of service codes which AHS manages on behalf of HMSA. All lines of business – commercial, Medicare, and QUEST Integration – are subject to AHS’ precertification review. Providers may submit precertification requests and/or questions 24/7 via AHS’:

Prior Authorization System (PAS) Portal
Phone: (844) 227-5769
Fax: (813) 751-3760

Frequently Asked Questions For Providers - Genetic Testing Management

HMSA Authorization Request Form

Additional policy links:

Medical Policies -
CURRENT

Medical Policies -
UNDER REVIEW

Medical Policies -
ARCHIVED (inactive)

Services That Require
Precertification

Policy quick links:

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

CURRENT GENETIC TESTING MEDICAL POLICIES

Policy Name	Notices	Current Effective Date	Policy #	Additional Information
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C				Back to top
Chromosomal Microarray		12/01/2025	AHS–M2033	Archived Policies
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E				Back to top
Esophageal Pathology Testing		02/01/2026	AHS–M2171	Archived Policies

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Fibromyalgia Testing		02/01/2026	AHS-M2177	Archived Policies
G				Back to top
Gene Expression Profiling and Protein Biomarkers for Prostate Cancer		12/01/2025	AHS–M2166	Archived Policies
General Genetic Testing, Germline Disorders		02/01/2025	AHS-M2145	Archived Policies
General Genetic Testing, Somatic Disorders		06/01/2023	AHS–M2146	Archived Policies
Genetic Cancer Susceptibility Using Next Generation Sequencing	60-day archival notice eff 02/01/2026	06/01/2023	AHS-M2066	Archived Policies
Genetic Markers for Assessing Risk of Cardiovascular Disease		12/01/2025	AHS–M2180	Archived Policies
Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma		06/01/2023	AHS–M2029	Archived Policies
Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma		02/01/2026	AHS-M2071	Archived Policies
Genetic Testing for Alpha- and Beta- Thalassemia		12/01/2025	AHS-M2131	Archived Policies
Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers Formerly: BRCA		02/01/2026	AHS–M2003	Archived Policies
Genetic Testing for CHARGE Syndrome		06/01/2023	AHS–M2070	Archived Policies
Genetic Testing for Connective Tissue Disorders		02/01/2026	AHS–M2144	Archived Policies
Genetic Testing for Cystic Fibrosis		12/01/2025	AHS-M2017	Archived Policies
Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies		12/01/2025	AHS-M2072	Archived Policies
Genetic Testing for Duchenne, Becker, Facioscapulohumeral, and Limb-Girdle Muscular Dystrophies		06/01/2023	AHS-M2074	Archived Policies
Genetic Testing for Epilepsy		02/01/2026	AHS-M2075	Archived Policies
Genetic Testing for Familial Alzheimer Disease		12/01/2025	AHS-M2038	Archived Policies
Genetic Testing for Familial Cutaneous Malignant Melanoma		06/01/2023	AHS-M2037	Archived Policies
Genetic Testing for Familial Hypercholesterolemia		12/01/2025	AHS-M2137	Archived Policies
Genetic Testing for Fanconi Anemia		06/01/2023	AHS-M2077	Archived Policies
Genetic Testing for FMR1 Mutations		06/01/2023	AHS-M2028	Archived Policies
Genetic Testing for Germline Mutations of the RET Proto-Oncogene		06/01/2023	AHS-M2078	Archived Policies
Genetic Testing for Hereditary Hearing Loss		12/01/2025	AHS-G2148	Archived Policies
Genetic Testing for Hereditary Hemochromatosis		06/01/2023	AHS-M2012	Archived Policies
Genetic Testing for Hereditary Pancreatitis		12/01/2025	AHS-M2079	Archived Policies
Genetic Testing for Inherited Cardiomyopathies and Channelopathies		06/01/2023	AHS-M2025	Archived Policies
Genetic Testing for Lactase Insufficiency		12/01/2025	AHS-M2080	Archived Policies
Genetic Testing for Li-Fraumeni Syndrome		12/01/2025	AHS-M2081	Archived Policies
Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment		06/01/2023	AHS-M2082	Archived Policies
Genetic Testing for Mental Health Disorders		06/01/2023	AHS-M2084	Archived Policies
Genetic Testing for Neurodegenerative Disorders		02/01/2026	AHS–M2167	Archived Policies
Genetic Testing for Neurofibromatosis and Related Disorders		12/01/2025	AHS-M2134	Archived Policies
Genetic Testing for Ophthalmologic Conditions		122/01/2025	AHS-M2083	Archived Policies
Genetic Testing for Polyposis Syndrome		02/01/2026	AHS-M2024	Archived Policies
Genetic Testing for PTEN Hamartoma Tumor Syndrome		12/01/2025	AHS-M2087	Archived Policies
Genetic Testing for Rett Syndrome		06/01/2023	AHS-M2088	Archived Policies
Genetic Testing of CADASIL Syndrome		06/01/2023	AHS-M2069	Archived Policies
Genetic Testing of Mitochondrial Disorders		06/01/2023	AHS-M2085	Archived Policies
Genome and Exome Sequencing Formerly: Whole Genome and Whole Exome Sequencing		12/01/2025	AHS-M2032	Archived Policies
Genomic Testing for Hematopoietic Neoplasms		02/01/2026	AHS-M2182	Archived Policies
H				Back to top

I				Back to top

J				Back to top

K				Back to top

L				Back to top
Laboratory Procedures Reimbursement Policy		03/01/2025	AHS-R2162	Archived Policies
Liquid Biopsy		02/01/2026	AHS-G2054	Archived Policies
Lynch Syndrome		02/01/2026	AHS-M2004	Archived Policies
M				Back to top
Microsatellite Instability and Tumor Mutational Burden Testing		12/01/2025	AHS-M2178	Archived Policies
Minimal Residual Disease		02/01/2026	AHS-M2175	Archived Policies
Molecular Analysis for Gliomas		02/01/2026	AHS–M2139	Archived Policies
Molecular Diagnostics for Breast Cancer Prognosis Formerly: Molecular Expression Testing for Breast Cancer Prognosis		02/01/2026	AHS-M2020	Archived Policies
Molecular Markers in Fine Needle Aspirates of the Thyroid		02/01/2026	AHS-M2108	Archived Policies
Molecular Profiling for Cancers of Unknown Primary Origin		12/01/2025	AHS-M2065	Archived Policies
Molecular Testing for Pulmonary Disease Formerly: Molecular Testing for Pulmonary Specimens		02/01/2026	AHS–M2160	Archived Policies
Multigene Expression Assay for Predicting Colon Cancer Recurrence		06/01/2023	AHS-M2111	Archived Policies
Mutation Analysis in Myeloproliferative Neoplasms		02/01/2026	AHS-M2101	Archived Policies

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Policy Name	Current Effective Date	Policy #	Additional Information
N			Back to top

O			Back to top

P			Back to top
Pancreatic Cancer Risk Testing Using Pancreatitis Cyst Fluid	06/01/2023	AHS-M2114	Archived Policies
Pharmacogenetic Testing	02/01/2026	AHS-M2021	Archived Policies
Pre-Implantation Genetic Testing	02/01/2026	AHS-M2039	Archived Policies
Prenatal Screening (Genetic)	02/01/2026	AHS-M2179	Archived Policies
Prenatal Testing for Fetal Aneuploidy	02/01/2025	AHS-G2055	Archived Policies
Proteogenomic Testing of Individuals with Cancer	02/01/2025	AHS-M2168	Archived Policies
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			Back to top
Red Blood Cell Molecular Testing	12/01/2025	AHS-M2170	Archived Policies
S			Back to top

T			Back to top
Testing for Alpha-1 Antitrypsin Deficiency	02/01/2026	AHS-M2068	Archived Policies
Testing for Autism Spectrum Disorder and Developmental Delay	06/01/2023	AHS-M2176	Archived Policies
Testing for Colorectal Cancer Management Formerly: KRAS NRAS BRAF Mutation Analysis in Colorectal Cancer	12/01/2025	AHS-M2026	Archived Policies
Testing for Targeted Therapy of Non-Small-Cell Lung Cancer	12/01/2025	AHS-M2030	Archived Policies
Testing of Homocysteine Metabolism-Related Conditions	06/01/2023	AHS-M2141	Archived Policies
Therapeutic Drug Monitoring for 5-Flurouracil	02/01/2025	AHS-M2067	Archived Policies
Transplant Rejection Testing	02/01/2026	AHS-M2091	Archived Policies
U			Back to top
Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer	02/01/2026	AHS-M2126	Archived Policies
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Venous and Arterial Thrombosis Risk Testing	02/01/2026	AHS-M2041	Archived Policies
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Z			Back to top

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ARCHIVED GTM POLICIES
Unless otherwise noted, archived policies are inactive. Since archived policies are not updated, these policies will no longer be used when reviewing requests for coverage and these services will no longer require prior authorization, unless noted.

Archived Policy Title	Policy Versions	Archived as of:
BCR-ABL 1 Testing - AHS-M2027	Archived Policies	02/01/2025
Genetic Testing for Acute Myeloid Leukemia - AHS-M2062	Archived Policies	02/01/2025

Avalon Healthcare Solutions is an independent company providing laboratory benefits management on behalf of HMSA.

Change History

Rev#:	Date:	Nature of Revision:
5.01	04/22/2026	1100-1677771-1831300 The following policies eff 2/1/2026, v2 have been posted: Esophageal Pathology Testing Fibromyalgia Testing Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma Genetic Testing for Breast_ Ovarian_ Pancreatic_ and Prostate Cancers Genetic Testing for Connective Tissue Disorders Genetic Testing for Neurodegenerative Disorders Genomic Testing for Hematopoietic Neoplasms Liquid Biopsy Lynch Syndrome Minimal Residual Disease (MRD) Molecular Analysis for Gliomas Molecular Diagnostics for Breast Ca Prognosis Molecular Markers in Fine Needle Aspirates of the Thyroid Molecular Testing for Pulmonary Disease Pharmacogenetic Testing Pre-Implantation Genetic Testing Prenatal Screening (Genetic) Testing for Alpha-1 Antitrypsin Deficiency Transplant Rejection Testing Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer Venous and Arterial Thrombosis Risk Testing
5.00	02/06/2026	1100-1677757-1720725 The following Genetic Testing Medical Policies effective 2/1/2026 have been posted: Esophageal Pathology Testing Fibromyalgia Testing Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma Genetic Testing for Breast_ Ovarian_ Pancreatic_ and Prostate Cancers Genetic Testing for Connective Tissue Disorders Genetic Testing for Epilepsy Genetic Testing for Neurodegenerative Disorders Genetic Testing for Polyposis Syndromes Genomic Testing for Hematopoietic Neoplasms Liquid Biopsy Lynch Syndrome Minimal Residual Disease (MRD) Molecular Analysis for Gliomas Molecular Diagnostics for Breast Ca Prognosis Molecular Markers in Fine Needle Aspirates of the Thyroid Molecular Testing for Pulmonary Disease (title change) Mutation Analysis in Myeloproliferative Neoplasms Pharmacogenetic Testing Pre-Implantation Genetic Testing Prenatal Screening (Genetic) Testing for Alpha-1 Antitrypsin Deficiency Transplant Rejection Testing Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer Venous and Arterial Thrombosis Risk Testing
4.08	12/08/2025	1100-1205577-1642525 Genetic Cancer Susceptibility Using Next Generation Sequencing ARCHIVAL 60-day notice effective 02/01/2026 has been posted. 1100-1205577-1635701 The following policies effective 12/01/2025 have been posted. ARCHIVED: 60-day notices and policies effective 02/01/2025 (unless noted). Chromosomal Microarray and Low-pass Whole Genome Sequencing Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Genetic Markers for Assessing Risk of Cardiovascular Disease Genetic Testing for Alpha- and Beta-Thalassemia Genetic Testing for Cystic Fibrosis Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies Genetic Testing for Familial Alzheimer Disease Genetic Testing for Familial Hypercholesterolemia Genetic Testing for Hereditary Hearing Loss Genetic Testing for Hereditary Pancreatitis Genetic Testing for Lactase Insufficiency Genetic Testing for Li-Fraumeni Syndrome Genetic Testing for Neurofibromatosis and Related Disorders Genetic Testing for Ophthalmologic Conditions Genetic Testing for PTEN Hamartoma Tumor Syndrome Genome and Exome Sequencing Microsatellite Instability and Tumor Mutational Burden Testing Molecular Profiling for Cancers of Unknown Primary Origin Prenatal Screening (Genetic) - archived 60-day notice and policy eff 3/1/2025 Red Blood Cell Molecular Testing Testing for Colorectal Cancer Management Testing for Targeted Therapy of Non-Small-Cell Lung Cancer - archived 60-day notice and policy eff 3/1/2025 1100-1205577-1642527 The following 60-day notices effective 02/01/2026 have been posted: Esophageal Pathology Testing Fibromyalgia Testing Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma Genetic Testing for Breast_ Ovarian_ Pancreatic_ and Prostate CancersGenetic Testing for Neurodegenerative Disorders Genetic Testing for Connective Tissue Disorders Genetic Testing for Epilepsy Genetic Testing for Neurodegenerative Disorders Genetic Testing for Polyposis Syndromes Genomic Testing for Hematopoietic Neoplasms Liquid Biopsy Lynch Syndrome Minimal Residual Disease (MRD) Molecular Analysis for Gliomas Molecular Diagnostics for Breast Ca Prognosis Molecular Markers in Fine Needle Aspirates of the Thyroid Molecular Testing for Pulmonary Disease Mutation Analysis in Myeloproliferative Neoplasms Pharmacogenetic Testing Pre-Implantation Genetic Testing Prenatal Screening (Genetic) Testing for Alpha-1 Antitrypsin Deficiency Transplant Rejection Testing Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer Venous and Arterial Thrombosis Risk Testing
4.07	10/06/2025	1100-1205563-1545452 The following 60-day notices effective 12/01/2025 have been posted: Chromosomal Microarray and Low-pass Whole Genome Sequencing Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Genetic Markers for Assessing Risk of Cardiovascular Disease Genetic Testing for Alpha- and Beta-Thalassemia Genetic Testing for Cystic Fibrosis Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies Genetic Testing for Familial Alzheimer Disease Genetic Testing for Familial Hypercholesterolemia Genetic Testing for Hereditary Hearing Loss Genetic Testing for Hereditary Pancreatitis Genetic Testing for Lactase Insufficiency Genetic Testing for Li-Fraumeni Syndrome Genetic Testing for Neurofibromatosis and Related Disorders Genetic Testing for Ophthalmologic Conditions Genetic Testing for PTEN Hamartoma Tumor Syndrome Genome and Exome Sequencing [formerly named: Whole Genome and Whole Exome Sequencing] Microsatellite Instability and Tumor Mutational Burden Molecular Profiling for Cancers of Unknown Primary Origin Prenatal Screening (Genetic) Red Blood Cell Molecular Testing Testing for Colorectal Cancer Management Testing for Targeted Therapy of Non-Small-Cell Lung Cancer
4.06	04/16/2025	1100-1205521-1312000 Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers, 2/1/2025, v2 has been posted.
4.05	03/11/2025	1100-1205514-1261250 The following policies effective 3/1/2025 have been posted: Laboratory Procedures Reimbursement Policy; ARCHIVED: 60-day notice and policy eff 6/1/2023 Microsatellite Instability and Tumor Mutational Burden Testing; ARCHIVED: 60-day notice and policy eff 9/1/2024 Molecular Analysis for Gliomas; ARCHIVED: 60-day notice and policy eff 6/1/2023 Prenatal Screening (Genetic); ARCHIVED: 60-day notice and policy eff 6/1/2023 Testing for Targeted Therapy of Non-Small-Cell Lung Cancer; ARCHIVED: 60-day notice and policy eff 6/1/2023 Transplant Rejection Testing; ARCHIVED: 60-day notice and policy eff 6/1/2023
4.04	02/13/2025	1100-1205507-1242500 The following policies effective 2/1/2025 have been posted. ARCHIVED: 60-day notices and policies eff 6/1/2023. 1. Chromosomal Microarray 2. Esophageal Pathology Testing 3. Fibromyalgia Testing 4. Gene Expression Profiling and Protein Biomarkers for Prostate Cancer 5. Genetic Markers for Assessing Risk of Cardiovascular Disease 6. Genetic Testing for Alpha- and Beta- Thalassemia 7. Genetic Testing for Connective Tissue Disorders 8. Genetic Testing for Cystic Fibrosis 9. Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies 10. Genetic Testing for Epilepsy 11. Genetic Testing for Familial Alzheimer Disease 12. Genetic Testing for Hereditary Hearing Loss 13. Genetic Testing for Hereditary Pancreatitis 14. Genetic Testing for Lactase Insufficiency 15. Genetic Testing for Neurofibromatosis and Related Disorders 16. Genetic Testing for Ophthalmologic Conditions 17. Genetic Testing for Polyposis Syndrome 18. Testing for Colorectal Cancer Management - Note policy title changed, previously titled: KRAS NRAS BRAF Mutation Analysis in Colorectal Cancer 19. Liquid Biopsy 20. Molecular Diagnostics for Breast Cancer Prognosis - Note: policy title changed, previously titled: Molecular Expression Testing for Breast Cancer Prognosis 21. Molecular Markers in Fine Needle Aspirates of the Thyroid 22. Molecular Profiling for Cancers of Unknown Primary Origin 23. Mutation Analysis in Myeloproliferative Neoplasms 24. Pharmacogenetic Testing 25. Pre-Implantation Genetic Testing 26. Red Blood Cell Molecular Testing 27. Testing for Alpha-1 Antitrypsin Deficiency 28. Whole Genome and Whole Exome Sequencing
4.03	02/12/2025	1100-1205507-1244500 Serum Testing for Evidence of Mild Traumatic Brain Injury has been removed from the GTM policy table. It can now be accessed on Routine Testing Management (RTM) Guidelines: Avalon
4.02	02/10/2025	1100-1205507-1241201 Removed the BRCA policy from the table as it has been renamed as "Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers". 1100-1205507-1234058 The following GTM policies effective 2/1/2025 have been archived. BCR-ABL 1 Testing AHS–M2027 Genetic Testing for Acute Myeloid Leukemia AHS-M2062 They have been moved to the archived policy table located below the current policy tables.
4.01	02/06/2025	1100-1205507-1234850 The following revised GTM 60-day notices effective 3/1/2025 have been posted (previously eff 2/1/2025): Microsatellite Instability and Tumor Mutational Burden Testing Molecular Analysis for Gliomas Prenatal Screening (Genetic) Testing for Targeted Therapy of Non-Small-Cell Lung Cancer Transplant Rejection Testing 1100-1205507-1234850 The following GTM 60-day notice effective 3/1/2025 has been posted: Laboratory Procedures Reimbursement Policy 1100-1205507-1234058 The following GTM policies effective 2/1/2025 have been posted: General Genetic Testing for Germline Disorders Genetic Cancer Susceptibility Using NGS Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers Genetic Testing for Familial Hypercholesterolemia Genetic Testing for Li-Fraumeni Syndrome Genetic Testing for Neurodegenerative Disorders Genetic Testing For PTEN Hamartoma Tumor Syndrome Genomic Testing for Hematopoietic Neoplasms Lynch Syndrome Minimal Residual Disease Molecular Testing of Pulmonary Specimens Prenatal Testing for Fetal Aneuploidy Proteogenomic Testing of Individuals with Cancer Therapeutic Drug Monitoring of 5-Fluorouracil Use of Common Genetic Variants Venous and Arterial Thrombosis Risk Testing Previous versions and 60-day notices can be accessed in respective archive folders.
4.0	01/07/2025	1100-1205500-1208149 The following 60-day notices eff 02/01/2025 have been posted: -Chromosomal Microarray and Low-pass Whole Genome Sequencing -Esophageal Pathology Testing -Fibromyalgia Testing -Gene Expression Profiling and Protein Biomarkers for Prostate Cancer -Genetic Markers for Assessing Risk of Cardiovascular Disease -Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma, v2 -Genetic Testing for Alpha- and Beta- Thalassemia -Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers, v2 -Genetic Testing for Connective Tissue Disorders -Genetic Testing for Cystic Fibrosis -Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies -Genetic Testing for Epilepsy -Genetic Testing for Familial Alzheimer Disease -Genetic Testing for Familial Hypercholesterolemia, v2 -Genetic Testing for Hereditary Hearing Loss -Genetic Testing for Hereditary Pancreatitis -Genetic Testing for Lactase Insufficiency -Genetic Testing for Li-Fraumeni Syndrome, v2 -Genetic Testing for Neurodegenerative Disorders, v2 -Genetic Testing for Neurofibromatosis and Related Disorders -Genetic Testing for Ophthalmologic Conditions -Genetic Testing for PTEN Hamartoma Tumor Syndrome, v2 -Genetic Testing for Polyposis Syndromes -Genomic Testing for Hematopoietic Neoplasms, v2 -Liquid Biopsy -Lynch Syndrome, v2 -Microsatellite Instability and Tumor Mutational Burden Testing, v2 -Minimal Residual Disease (MRD), v2 -Molecular Analysis for Gliomas, v2 -Molecular Diagnostics for Breast Cancer Prognosis -Molecular Markers in Fine Needle Aspirates of the Thyroid -Molecular Profiling for Cancers of Unknown Primary Origin -Molecular Testing for Pulmonary Disease, v2 -Mutation Analysis in Myeloproliferative Neoplasms -Pharmacogenetic Testing -Pre-Implantation Genetic Testing -Prenatal Screening (Genetic) -Red Blood Cell Molecular Testing -Testing for Alpha-1 Antitrypsin Deficiency -Testing for Colorectal Cancer Management -Transplant Rejection Testing, v2 -Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer, v2 -Venous and Arterial Thrombosis Risk Testing, v2 -Whole Genome and Whole Exome Sequencing
3.10	12/12/2024	1100-956557-1195351 The following 60-day notices eff 02/01/2025 (replacing the notice eff 11/1/2024) have been posted: BCR-ABL 1 Testing; Archival 60-day notice (Superseded by AHS-M2182 - Genomic Testing for Hematopoietic Neoplasms) General Genetic Testing, Germline Disorders Genetic Cancer Susceptibility Using Next Generation Sequencing Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma Genetic Testing for Acute Myeloid Leukemia (Archival 60-day notice) Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers (Note: Policy title CHANGE, previously titled BRCA) Genetic Testing for Familial Hypercholesterolemia Genetic Testing for Li-Fraumeni Syndrome Genetic Testing for Neurodegenerative Disorders Genetic Testing for PTEN Hamartoma Tumor Syndrome Genomic Testing for Hematopoietic Neoplasms Lynch Syndrome Microsatellite Instability and Tumor Mutational Burden Testing Minimal Residual Disease Molecular Analysis for Gliomas; Molecular Testing for Pulmonary Disease Prenatal Testing for Fetal Aneuploidy (Note: Policy title CHANGED, previously Prenatal Screening for Fetal Aneuploidy) Proteogenomic Testing of Individuals with Cancer Testing for Targeted Therapy of Non-Small-Cell Lung Cancer Therapeutic Drug Monitoring for 5-Fluorouracil Transplant Rejection Testing Use of Common Genetic Variants (Single Nucleotide Polymorphisms) to Predict Risk of Non-Familial Breast Cancer Venous and Arterial Thrombosis Risk Testing
3.9 (v37)	09/05/2024	1100-956542-1128400 The following policy has been posted: Microsatellite Instability and Tumor Mutational Burden Testing, eff 9/1/2024 The following policy has been removed: Microsatellite Instability and Tumor Mutational Burden Testing, 60-day notice eff 11/1/2024
3.8 (v36)	07/26/2024	1100-956527-1098250 The following 60-day notices eff 11/1/2024 (replacing the notice eff 10/1/2024) have been posted: BCR-ABL 1 Testing; Archival 60-day notice (Superseded by AHS-M2182 - Genomic Testing for Hematopoietic Neoplasms) General Genetic Testing, Germline Disorders Genetic Cancer Susceptibility Using Next Generation Sequencing Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma Genetic Testing for Acute Myeloid Leukemia (Archival 60-day notice) Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers (Note: Policy title CHANGE, previously titled BRCA) Genetic Testing for Familial Hypercholesterolemia Genetic Testing for Li-Fraumeni Syndrome Genetic Testing for Neurodegenerative Disorders Genetic Testing for PTEN Hamartoma Tumor Syndrome Genomic Testing for Hematopoietic Neoplasms Lynch Syndrome Microsatellite Instability and Tumor Mutational Burden Testing Minimal Residual Disease Molecular Analysis for Gliomas; Molecular Testing for Pulmonary Disease Prenatal Testing for Fetal Aneuploidy (Note: Policy title CHANGED, previously Prenatal Screening for Fetal Aneuploidy) Proteogenomic Testing of Individuals with Cancer Testing for Targeted Therapy of Non-Small-Cell Lung Cancer Therapeutic Drug Monitoring for 5-Fluorouracil Transplant Rejection Testing Use of Common Genetic Variants (Single Nucleotide Polymorphisms) to Predict Risk of Non-Familial Breast Cancer Venous and Arterial Thrombosis Risk Testing
3.7 (v35)	06/13/2024	1100-956527-1073950 The following 60-day notices eff 10/1/2024, v2 have been posted: Genetic Testing for PTEN Hamartoma Tumor Syndrome Genomic Testing for Hematopoietic Neoplasms
3.6 (v34)	06/12/2024	1100-956527-1073950 The following 60-day notices eff 10/1/2024 (replacing the notice eff 7/1/2024) have been posted: BCR-ABL 1 Testing; Archival 60-day notice (Superseded by AHS-M2182 - Genomic Testing for Hematopoietic Neoplasms) General Genetic Testing, Germline Disorders Genetic Cancer Susceptibility Using Next Generation Sequencing Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma Genetic Testing for Acute Myeloid Leukemia (Archival 60-day notice) Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers (Note: Policy title CHANGE, previously titled BRCA) Genetic Testing for Familial Hypercholesterolemia Genetic Testing for Li-Fraumeni Syndrome Genetic Testing for Neurodegenerative Disorders Genetic Testing for PTEN Hamartoma Tumor Syndrome Genomic Testing for Hematopoietic Neoplasms Lynch Syndrome Microsatellite Instability and Tumor Mutational Burden Testing Minimal Residual Disease Molecular Analysis for Gliomas; Molecular Testing for Pulmonary Disease Prenatal Testing for Fetal Aneuploidy (Note: Policy title CHANGED, previously Prenatal Screening for Fetal Aneuploidy) Proteogenomic Testing of Individuals with Cancer Testing for Targeted Therapy of Non-Small-Cell Lung Cancer Therapeutic Drug Monitoring for 5-Fluorouracil Transplant Rejection Testing Use of Common Genetic Variants (Single Nucleotide Polymorphisms) to Predict Risk of Non-Familial Breast Cancer Venous and Arterial Thrombosis Risk Testing
3.5 (v33)	04/22/2024	Link fix for Genetic Testing for Ophthalmologic Conditions.
3.4 (v32)	04/08/2024	The following policies have been posted: BCR-ABL 1 Testing; Archival 60-day notice (Superseded by AHS-M2182 - Genomic Testing for Hematopoietic Neoplasms) General Genetic Testing, Germline Disorders Genetic Cancer Susceptibility Using Next Generation Sequencing Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma; Replaces previous 60-day notice eff 3/1/24. Genetic Testing for Acute Myeloid Leukemia; Archival 60-day notice replaces previous 60-day notice eff 3/1/24. Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers (Note: Policy title CHANGE, previously titled BRCA) Replaces previous 60-day notice eff 3/1/24. Genetic Testing for Familial Hypercholesterolemia; Replaces previous 60-day notice eff 3/1/24. Genetic Testing for Li-Fraumeni Syndrome; Replaces previous 60-day notice eff 3/1/24. Genetic Testing for Neurodegenerative Disorders; Replaces previous 60-day notice eff 3/1/24. Genetic Testing for PTEN Hamartoma Tumor Syndrome; Replaces previous 60-day notice eff 3/1/24. (NEW) Genomic Testing for Hematopoietic Neoplasms Lynch Syndrome; Replaces previous 60-day notice eff 3/1/24. Microsatellite Instability and Tumor Mutational Burden Testing Minimal Residual Disease; Replaces previous 60-day notice eff 3/1/24. Molecular Analysis for Gliomas; Replaces previous 60-day notice eff 3/1/24. Molecular Testing for Pulmonary Disease; Replaces previous 60-day notice eff 3/1/24. Prenatal Testing for Fetal Aneuploidy (Note: Policy title CHANGED, previously Prenatal Screening for Fetal Aneuploidy); Replaces previous 60-day notice eff 3/1/24. Proteogenomic Testing of Individuals with Cancer; Replaces previous 60-day notice eff 3/1/24. Testing for Targeted Therapy of Non-Small-Cell Lung Cancer Therapeutic Drug Monitoring for 5-Fluorouracil; Replaces previous 60-day notice eff 3/1/24. Transplant Rejection Testing; Replaces previous 60-day notice eff 3/1/24. Use of Common Genetic Variants (Single Nucleotide Polymorphisms) to Predict Risk of Non-Familial Breast Cancer; Replaces previous 60-day notice eff 3/1/24. Venous and Arterial Thrombosis Risk Testing
3.3 (v31)	02/26/2024	Added links to respective archived policy folders.
3.2 (v30)	01/19/2024	Type edit fix. Disclosure statement added to the summary section.
3.1 (v29)	01/03/2024	New policy added eff 3/1/2024 Genomic Testing for Hematopoietic Neoplasms (AHS–M2182)
3.0 (v28)	01/03/2024	60-day notices have been posted for the following policies eff 3/1/2024: Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma (AHS-M2071) Genetic Testing for Breast, Ovarian, Pancreatic, and Prostate Cancers (Formerly BRCA) (AHS – M2003) Genetic Testing for Familial Hypercholesterolemia (AHS-M2137) Genetic Testing For Li-Fraumeni Syndrome (AHS-M2081) Genetic Testing for Neurodegenerative Disorders (AHS–M2167) Genetic Testing For PTEN Hamartoma Tumor Syndrome (AHS-M2087) Lynch Syndrome (AHS-M2004) Minimal Residual Disease (MRD) (AHS-M2175) Molecular Analysis for Gliomas (AHS–M2139) Molecular Testing of Pulmonary Specimens (AHS-M2160) Prenatal Screening for Fetal Aneuploidy (AHS-G2055) Proteogenomic Testing of Individuals with Cancer (AHS-M2168) Therapeutic Drug Monitoring for 5-Fluorouracil (AHS-M2067) Transplant Rejection Testing (AHS-M2091) Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer (AHS-M2126)
2.5 (v27)	12/21/2023 (published on 12/27/2023)	The following policies effective 6/1/2023 has been updated to version 2. BCR-ABL 1 Testing (AHS–M2027) BRCA (AHS–M2003) Chromosomal Microarray (AHS–M2033) Esophageal Pathology Testing (AHS–M2171) Fibromyalgia Testing (AHS-M2177) Gene Expression Profiling and Protein Biomarkers for Prostate Cancer(AHS–M2166) General Genetic Testing, Germline Disorders (AHS-M2145) General Genetic Testing, Somatic Disorders (AHS–M2146) Genetic Cancer Susceptibility Using Next Generation Sequencing (AHS-M2066) Genetic Markers for Assessing Risk of Cardiovascular Disease (AHS–M2180) Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma (AHS–M2029) Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma(AHS–M2071) Genetic Testing for Acute Myeloid Leukemia (AHS-M2062) Genetic Testing for Alpha- and Beta- Thalassemia (AHS-M2131) Genetic Testing for CHARGE Syndrome (AHS–M2070) Genetic Testing for Connective Tissue Disorders (AHS–M2144) Genetic Testing for Cystic Fibrosis (AHS-M2017) Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies (AHS-M2072) Genetic Testing for Duchenne, Becker, Facioscapulohumeral, and Limb-Girdle Muscular Dystrophies (AHS-M2074) Genetic Testing for Epilepsy (AHS-M2075) Genetic Testing for Familial Alzheimer Disease (AHS-M2038) Genetic Testing for Familial Cutaneous Malignant Melanoma (AHS-M2037) Genetic Testing for Familial Hypercholesterolemia (AHS-M2137) Genetic Testing for Fanconi Anemia (AHS-M2077) Genetic Testing for FMR1 Mutations (AHS-M2028) Genetic Testing for Germline Mutations of the RET Proto-Oncogene (AHS-M2078) Genetic Testing for Hereditary Hearing Loss (AHS-G2148) Genetic Testing for Hereditary Hemochromatosis (AHS-M2012) Genetic Testing for Hereditary Pancreatitis (AHS-M2079) Genetic Testing for Inherited Cardiomyopathies and Channelopathies (AHS-M2025) Genetic Testing for Lactase Insufficiency (AHS-M2080) Genetic Testing for Li-Fraumeni Syndrome (AHS-M2081) Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment (AHS-M2082) Genetic Testing for Mental Health Disorders (AHS-M2084) Genetic Testing for Neurodegenerative Disorders (AHS–M2167) Genetic Testing for Neurofibromatosis and Related Disorders (AHS-M2134) Genetic Testing for Ophthalmologic Conditions (AHS-M2083) Genetic Testing for Polyposis Syndrome (AHS-M2024) Genetic Testing for PTEN Hamartoma Tumor Syndrome (AHS-M2087) Genetic Testing for Rett Syndrome (AHS-M2088) Genetic Testing of CADASIL Syndrome (AHS-2069) Genetic Testing of Mitochondrial Disorders (AHS-M2085) KRAS NRAS BRAF Mutation Analysis in Colorectal Cancer (AHS-M2026) Laboratory Procedures Reimbursement Policy (AHS-R2162) Liquid Biopsy (AHS-G2054) Lynch Syndrome (AHS–M2004) Microsatellite Instability and Tumor Mutational Burden Testing (AHS-M2178) Minimal Residual Disease (AHS–M2175) Molecular Analysis for Gliomas (AHS–M2139) Molecular Expression Testing for Breast Cancer Prognosis (AHS-M2020) Molecular Markers in Fine Needle Aspirates of the Thyroid (AHS-M2108) Molecular Profiling for Cancers of Unknown Primary Origin (AHS-M2065) Molecular Testing of Pulmonary Disease (AHS–M2160) Multigene Expression Assay for Predicting Colon Cancer Recurrence (AHS-M2111) Mutation Analysis in Myeloproliferative Neoplasms (AHS-M2101) Pancreatic Cancer Risk Testing Using Pancreatitis Cyst Fluid (AHS-M2114) Pharmacogenetic Testing (AHS-M2021) Pre-Implantation Genetic Testing (AHS-M2039) Prenatal Screening (Genetic) (AHS-M2179) Proteogenomic Testing of Individuals with Cancer (AHS-M2168) Red Blood Cell Molecular Testing (AHS-M2170) Serum Testing for Evidence of Mild Traumatic Brain Injury (AHS-G2151) Testing for Alpha-1 Antitrypsin Deficiency (AHS-M2068) Testing for Autism Spectrum Disorder and Developmental Delay (AHS-M2176) Testing for Targeted Therapy of Non-Small-Cell Lung Cancer (AHS-M2030) Testing of Homocysteine Metabolism-Related Conditions (AHS-M2141) Therapeutic Drug Monitoring for 5-Flurouracil (AHS-M2067) Transplant Rejection Testing (AHS-M2091) Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer (AHS-M2126) Venous and Arterial Thrombosis Risk Testing (AHS-M2041) Whole Genome and Whole Exome Sequencing (AHS-M2032) Prenatal Screening for Fetal Aneuploidy (AHS-G2055) eff 10/1/2023, v2 has been posted
2.4 (v26)	10/06/2023	The following policy has been posted: Prenatal Screening for Fetal Aneuploidy, 10/1/2023; archived: 60-day provider notice
2.3 (v25)	09/20/2023	Minor revision to an anchor link.
2.2 (v24)	08/01/2023	The following policy has been posted: Prenatal Screening for Fetal Aneuploidy, 60-day provider notice eff 10/1/2023
2.1 (v23)	06/05/2023	Added the following links: Frequently Asked Questions For Providers - Genetic Testing Management HMSA Authorization Request Form
2.0 (v22)	05/31/2023	Copy has been updated to reflect the implementation of the new GTM program. Policies are effective 6/1/2023. The dates have been added to the index tables.
1.19 (v21)	05/09/2023	All 71 policies have been updated and posted reflecting the new effective date, 6/1/2023.
1.18 (v20)	05/03/2023	The implementation date has been moved to June 1, 2023. The copy has been updated to reflect the new effective date.
1.17 (v19)	04/24/2023	Minor fixes to anchor links.
1.16 (v18)	04/19/2023	Added anchor links to all of the policy numbers.
1.15 (v17)	04/04/2023	The following policy has been posted and added to the table: Laboratory Procedures Reimbursement Policy (AHS-R2162), 5/1/2023
1.14 (v16)	03/31/2023	The following policies have been posted: BCR-ABL 1 Testing (AHS–M2027), 5/1/2023 BRCA (AHS–M2003), 5/1/2023 Chromosomal Microarray (AHS–M2033), 5/1/2023 Esophageal Pathology Testing (AHS–M2171), 5/1/2023 Fibromyalgia Testing (AHS-M2177), 5/1/2023 Gene Expression Profiling and Protein Biomarkers for Prostate Cancer(AHS–M2166), 5/1/2023 General Genetic Testing, Germline Disorders (AHS-M2145), 5/1/2023 General Genetic Testing, Somatic Disorders (AHS–M2146), 5/1/2023 Genetic Cancer Susceptibility Using Next Generation Sequencing (AHS-M2066), 5/1/2023 Genetic Markers for Assessing Risk of Cardiovascular Disease (AHS–M2180) , 5/1/2023 Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma (AHS–M2029), 5/1/2023 Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma(AHS–M2071), 5/1/2023 Genetic Testing for Acute Myeloid Leukemia (AHS-M2062), 5/1/2023 Genetic Testing for Alpha- and Beta- Thalassemia (AHS-M2131), 5/1/2023 Genetic Testing for CHARGE Syndrome (AHS–M2070), 5/1/2023 Genetic Testing for Connective Tissue Disorders (AHS–M2144), 5/1/2023 Genetic Testing for Cystic Fibrosis (AHS-M2017), 5/1/2023 Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies (AHS-M2072), 5/1/2023 Genetic Testing for Duchenne, Becker, Facioscapulohumeral, and Limb-Girdle Muscular Dystrophies (AHS-M2074), 5/1/2023 Genetic Testing for Epilepsy (AHS-M2075) , 5/1/2023 Genetic Testing for Familial Alzheimer Disease (AHS-M2038), 5/1/2023 Genetic Testing for Familial Cutaneous Malignant Melanoma (AHS-M2037), 5/1/2023 Genetic Testing for Familial Hypercholesterolemia (AHS-M2137), 5/1/2023 Genetic Testing for Fanconi Anemia (AHS-M2077), 5/1/2023 Genetic Testing for FMR1 Mutations (AHS-M2028), 5/1/2023 Genetic Testing for Germline Mutations of the RET Proto-Oncogene (AHS-M2078), 5/1/2023 Genetic Testing for Hereditary Hearing Loss (AHS-G2148), 5/1/2023 Genetic Testing for Hereditary Hemochromatosis (AHS-M2012), 5/1/2023 Genetic Testing for Hereditary Pancreatitis (AHS-M2079), 5/1/2023 Genetic Testing for Inherited Cardiomyopathies and Channelopathies (AHS-M2025), 5/1/2023 Genetic Testing for Lactase Insufficiency (AHS-M2080), 5/1/2023 Genetic Testing for Li-Fraumeni Syndrome (AHS-M2081), 5/1/2023 Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment (AHS-M2082), 5/1/2023 Genetic Testing for Mental Health Disorders (AHS-M2084), 5/1/2023 Genetic Testing for Neurodegenerative Disorders (AHS–M2167), 5/1/2023 Genetic Testing for Neurofibromatosis and Related Disorders (AHS-M2134), 5/1/2023 Genetic Testing for Ophthalmologic Conditions (AHS-M2083), 5/1/2023 Genetic Testing for Polyposis Syndrome (AHS-M2024), 5/1/2023 Genetic Testing for PTEN Hamartoma Tumor Syndrome (AHS-M2087), 5/1/2023 Genetic Testing for Rett Syndrome (AHS-M2088), 5/1/2023 Genetic Testing of CADASIL Syndrome (AHS-M2069), 5/1/2023 Genetic Testing of Mitochondrial Disorders (AHS-M2085), 5/1/2023 KRAS NRAS BRAF Mutation Analysis in Colorectal Cancer (AHS-M2026), 5/1/2023 Liquid Biopsy (AHS-G2054), 5/1/2023 Lynch Syndrome (AHS–M2004), 5/1/2023 Microsatellite Instability and Tumor Mutational Burden Testing (AHS-M2178), 5/1/2023 Minimal Residual Disease (AHS–M2175), 5/1/2023 Molecular Analysis for Gliomas (AHS–M2139), 5/1/2023 Molecular Expression Testing for Breast Cancer Prognosis (AHS-M2020), 5/1/2023 Molecular Markers in Fine Needle Aspirates of the Thyroid (AHS-M2108), 5/1/2023 Molecular Profiling for Cancers of Unknown Primary Origin (AHS-M2065), 5/1/2023 Molecular Testing of Pulmonary Disease (AHS–M2160), 5/1/2023 Multigene Expression Assay for Predicting Colon Cancer Recurrence (AHS-M2111), 5/1/2023 Mutation Analysis in Myeloproliferative Neoplasms (AHS-M2101), 5/1/2023 Pancreatic Cancer Risk Testing Using Pancreatitis Cyst Fluid (AHS-M2114), 5/1/2023 Pharmacogenetic Testing (AHS-M2021), 5/1/2023 Pre-Implantation Genetic Testing (AHS-M2039), 5/1/2023 Prenatal Screening (Genetic) (AHS-M2179), 5/1/2023 Proteogenomic Testing of Individuals with Cancer (AHS-M2168), 5/1/2023 Red Blood Cell Molecular Testing (AHS-M2170), 5/1/2023 Serum Testing for Evidence of Mild Traumatic Brain Injury (AHS-G2151), 5/1/2023 Testing for Alpha-1 Antitrypsin Deficiency (AHS-M2068), 5/1/2023 Testing for Autism Spectrum Disorder and Developmental Delay (AHS-M2176), 5/1/2023 Testing for Targeted Therapy of Non-Small-Cell Lung Cancer (AHS-M2030), 5/1/2023 Testing of Homocysteine Metabolism-Related Conditions (AHS-M2141), 5/1/2023 Therapeutic Drug Monitoring for 5-Flurouracil (AHS-M2067), 5/1/2023 Transplant Rejection Testing (AHS-M2091), 5/1/2023 Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer (AHS-M2126), 5/1/2023 Venous and Arterial Thrombosis Risk Testing (AHS-M2041), 5/1/2023 Whole Genome and Whole Exome Sequencing (AHS-M2032), 5/1/2023 Updated the information regarding effective dates and precertification.
1.13 (v15)	02/21/2023	The following policies have been posted: BRCA (AHS–M2003), eff 4/1/2023 Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma (AHS–M2029), eff 4/1/2023 Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma (AHS-M2071), eff 4/1/2023 v2 Genetic Testing for Connective Tissue Disorders (AHS–M2144), eff 4/1/2023 Genetic Testing for Familial Hypercholesterolemia (AHS–M2137), eff 4/1/2023 v2 Genetic Testing for Inherited Cardiomyopathies and Channelopathies (AHS–M2025), eff 4/1/2023 v2 Genetic Testing for Neurodegenerative Disorders (AHS–M2167), eff 4/1/2023 Lynch Syndrome (AHS–M2004), eff 4/1/2023 Minimal Residual Disease (AHS–M2175), eff 4/1/2023 Molecular Analysis for Gliomas (AHS–M2139), eff 4/1/2023 Molecular Testing of Pulmonary Disease (AHS–M2160), eff 4/1/2023 v2 Proteogenomic Testing of Individuals with Cancer (AHS–M2168), eff 4/1/2023 v2 Therapeutic Drug Monitoring for 5-Fluorouracil (AHS–M2067), eff 4/1/2023 v2 Transplant Rejection Testing (AHS–M2091), eff 4/1/2023 v2 Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast (AHS–M2126), eff 4/1/2023 v2 Whole Genome and Whole Exome Sequencing (AHS–M2032), eff 4/1/2023 v2
1.12 (v14)	02/16/2023	Metadata updated for Genetic Testing for Epilepsy (AHS-M2075); no change to policy.
1.11 (v13)	02/15/2023	The following 63 policies were posted with an effective date of 04/01/2023: BCR-ABL 1 Testing (AHS–M2027) Chromosomal Microarray (AHS–M2033) Esophageal Pathology Testing (AHS–M2171) Fibromyalgia Testing (AHS-M2177) Gene Expression Profiling and Protein Biomarkers for Prostate Cancer(AHS–M2166) General Genetic Testing, Germline Disorders (AHS-M2145) General Genetic Testing, Somatic Disorders (AHS–M2146) Genetic Cancer Susceptibility Using Next Generation Sequencing (AHS-M2066) Genetic Markers for Assessing Risk of Cardiovascular Disease (AHS–M2180) Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma(AHS–M2071) Genetic Testing for Acute Myeloid Leukemia (AHS-M2062) Genetic Testing for Alpha- and Beta- Thalassemia (AHS-M2131) Genetic Testing for CHARGE Syndrome (AHS–M2070) Genetic Testing for Cystic Fibrosis (AHS-M2017) Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies (AHS-M2072) Genetic Testing for Duchenne, Becker, Facioscapulohumeral, and Limb-Girdle Muscular Dystrophies (AHS-M2074) Genetic Testing for Epilepsy (AHS-M2075) Genetic Testing for Familial Alzheimer Disease (AHS-M2038) Genetic Testing for Familial Cutaneous Malignant Melanoma (AHS-M2037) Genetic Testing for Familial Hypercholesterolemia (AHS-M2137) Genetic Testing for Fanconi Anemia (AHS-M2077) Genetic Testing for FMR1 Mutations (AHS-M2028) Genetic Testing for Germline Mutations of the RET Proto-Oncogene (AHS-M2078) Genetic Testing for Hereditary Hearing Loss (AHS-G2148) Genetic Testing for Hereditary Hemochromatosis (AHS-M2012) Genetic Testing for Hereditary Pancreatitis (AHS-M2079) Genetic Testing for Inherited Cardiomyopathies and Channelopathies (AHS-M2025) Genetic Testing for Lactase Insufficiency (AHS-M2080) Genetic Testing for Li-Fraumeni Syndrome (AHS-M2081) Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment (AHS-M2082) Genetic Testing for Mental Health Disorders (AHS-M2084) Genetic Testing for Neurofibromatosis and Related Disorders (AHS-M2134) Genetic Testing for Ophthalmologic Conditions (AHS-M2083) Genetic Testing for Polyposis Syndrome (AHS-M2024) Genetic Testing for PTEN Hamartoma Tumor Syndrome (AHS-M2087) Genetic Testing for Rett Syndrome (AHS-M2088) Genetic Testing of CADASIL Syndrome (AHS-2069) Genetic Testing of Mitochondrial Disorders (AHS-M2085) KRAS NRAS BRAF Mutation Analysis in Colorectal Cancer (AHS-M2026) Liquid Biopsy (AHS-G2054) Microsatellite Instability and Tumor Mutational Burden Testing (AHS-M2178) Molecular Expression Testing for Breast Cancer Prognosis (AHS-M2020) Molecular Markers in Fine Needle Aspirates of the Thyroid (AHS-M2108) Molecular Profiling for Cancers of Unknown Primary Origin (AHS-M2065) Molecular Testing of Pulmonary Disease (AHS–M2160) Multigene Expression Assay for Predicting Colon Cancer Recurrence (AHS-M2111) Mutation Analysis in Myeloproliferative Neoplasms (AHS-M2101) Pancreatic Cancer Risk Testing Using Pancreatitis Cyst Fluid (AHS-M2114) Pharmacogenetic Testing (AHS-M2021) Pre-Implantation Genetic Testing (AHS-M2039) Prenatal Screening (Genetic) (AHS-M2179) Proteogenomic Testing of Individuals with Cancer (AHS-M2168) Red Blood Cell Molecular Testing (AHS-M2170) Serum Testing for Evidence of Mild Traumatic Brain Injury (AHS-G2151) Testing for Alpha-1 Antitrypsin Deficiency (AHS-M2068) Testing for Autism Spectrum Disorder and Developmental Delay (AHS-M2176) Testing for Targeted Therapy of Non-Small-Cell Lung Cancer (AHS-M2030) Testing of Homocysteine Metabolism-Related Conditions (AHS-M2141) Therapeutic Drug Monitoring for 5-Flurouracil (AHS-M2067) Transplant Rejection Testing (AHS-M2091) Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer (AHS-M2126) Venous and Arterial Thrombosis Risk Testing (AHS-M2041) Whole Genome and Whole Exome Sequencing (AHS-M2032)
1.10 (v12)	02/13/2023	Updated the copy to reflect the effective date of the policies - April 1, 2023.
1.9 (v11)	12/20/2022	The following policies have been posted: Genetic Testing for Familial Hypercholesterolemia (AHS-M2137), v4 Genetic Testing for Inherited Cardiomyopathies and Channelopathies (AHS-M2025), v3 Minimal Residual Disease (MRD) (AHS–M2175), v2
1.8 (v10)	12/16/2022	The following policies have been posted: BRCA Genetic Testing for Connective Tissue Disorders Genetic Testing for inherited Cardiomyopathies and Channelopathies Genetic Testing for Familial Hypercholesterolemia Genetic Testing for Neurodegenerative Disorders Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma (AHS-M2071), v2 Lynch Syndrome Minimal Residual Disease Molecular Analysis for Gliomas Molecular Testing of Pulmonary Specimens Proteogenomic Testing of Individuals with Cancer (AHS–M2168), v2 Therapeutic Drug Monitoring for 5-Fluorouracil (AHS–M2067), v2 Transplant Rejection Testing (AHS–M2091), v2 Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast (AHS–M2126), v2 Whole Genome and Whole Exome Sequencing
1.7 (v9)	12/14/2022	The following policies were posted: Whole Genome and Whole Exome Sequencing, v2 Venous and Arterial Thrombosis Risk Testing, v2 The following note was added: Until these policies are effective, providers will need to use the HMSA policies.
1.6 (v8)	12/13/2022	Corrected the following link: General Genetic Testing, Germline Disorders (AHS-M2145)
1.5 (v7)	11/29/2022	The following policies were posted: Genetic Testing for Familial Alzheimer Disease (AHS-M2038), v2 Genetic Testing for Familial Hypercholesterolemia (AHS-M2137), v2
1.4 (v6)	11/23/2022	The following policies were posted: BCR-ABL 1 Testing (AHS–M2027) Chromosomal Microarray (AHS–M2033) Esophageal Pathology Testing (AHS–M2171) Fibromyalgia Testing (AHS-M2177) Gene Expression Profiling and Protein Biomarkers for Prostate Cancer(AHS–M2166) General Genetic Testing, Germline Disorders (AHS-M2145) General Genetic Testing, Somatic Disorders (AHS–M2146) Genetic Cancer Susceptibility Using Next Generation Sequencing (AHS-M2066) Genetic Markers for Assessing Risk of Cardiovascular Disease (AHS–M2180) Genetic Testing for Acute Myeloid Leukemia (AHS-M2062) Genetic Testing for Alpha- and Beta- Thalassemia (AHS-M2131) Genetic Testing for CHARGE Syndrome (AHS–M2070) Genetic Testing for Cystic Fibrosis (AHS-M2017) Genetic Testing for Diagnosis of Inherited Peripheral Neuropathies (AHS-M2072) Genetic Testing for Duchenne, Becker, Facioscapulohumeral, and Limb-Girdle Muscular Dystrophies (AHS-M2074) Genetic Testing for Epilepsy (AHS-M2075) (Posted 11/22/22) Genetic Testing and Genetic Expression Profiling in Patients with Uveal Melanoma (AHS-M2071) Genetic Testing for Familial Alzheimer Disease (AHS-M2038) Genetic Testing for Familial Cutaneous Malignant Melanoma (AHS-M2037) Genetic Testing for Familial Hypercholesterolemia (AHS-M2137) Genetic Testing for Fanconi Anemia (AHS-M2077) Genetic Testing for FMR1 Mutations (AHS-M2028) Genetic Testing for Germline Mutations of the RET Proto-Oncogene (AHS-M2078) Genetic Testing for Hereditary Hearing Loss (AHS-G2148) Genetic Testing for Hereditary Hemochromatosis (AHS-M2012) Genetic Testing for Hereditary Pancreatitis (AHS-M2079) Genetic Testing for Inherited Cardiomyopathies and Channelopathies (AHS-M2025) Genetic Testing for Lactase Insufficiency (AHS-M2080) Genetic Testing for Li-Fraumeni Syndrome (AHS-M2081) Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment and/or CVD Risk Assessment (AHS-M2082) Genetic Testing for Mental Health Disorders (AHS-M2084) Genetic Testing for Neurofibromatosis and Related Disorders (AHS-M2134) Genetic Testing for Ophthalmologic Conditions (AHS-M2083) Genetic Testing for Polyposis Syndrome (AHS-M2024) Genetic Testing for PTEN Hamartoma Tumor Syndrome (AHS-M2087) Genetic Testing for Rett Syndrome (AHS-M2088) Genetic Testing of CADASIL Syndrome (AHS-2069) Genetic Testing of Mitochondrial Disorders (AHS-M2085) KRAS NRAS BRAF Mutation Analysis in Colorectal Cancer (AHS-M2026) Liquid Biopsy (AHS-G2054) Microsatellite Instability and Tumor Mutational Burden Testing (AHS-M2178) Molecular Expression Testing for Breast Cancer Prognosis (AHS-M2020) Molecular Markers in Fine Needle Aspirates of the Thyroid (AHS-M2108) Molecular Profiling for Cancers of Unknown Primary Origin (AHS-M2065) Multigene Expression Assay for Predicting Colon Cancer Recurrence (AHS-M2111) Mutation Analysis in Myeloproliferative Neoplasms (AHS-M2101) Pancreatic Cancer Risk Testing Using Pancreatitis Cyst Fluid (AHS-M2114) Pharmacogenetic Testing (AHS-M2021) Pre-Implantation Genetic Testing (AHS-M2039) Prenatal Screening (Genetic) (AHS-M2179) Proteogenomic Testing of Individuals with Cancer (AHS-M2168) Red Blood Cell Molecular Testing (AHS-M2170) Serum Testing for Evidence of Mild Traumatic Brain Injury (AHS-G2151) Testing for Alpha-1 Antitrypsin Deficiency (AHS-M2068) Testing for Autism Spectrum Disorder and Developmental Delay (AHS-M2176) Testing for Targeted Therapy of Non-Small-Cell Lung Cancer (AHS-M2030) Testing of Homocysteine Metabolism-Related Conditions (AHS-M2141) Therapeutic Drug Monitoring for 5-Flurouracil (AHS-M2067) Transplant Rejection Testing (AHS-M2091) Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Non-Familial Breast Cancer (AHS-M2126) Venous and Arterial Thrombosis Risk Testing (AHS-M2041) Whole Genome and Whole Exome Sequencing (AHS-M2032)
1.3 (v5)	11/22/2022	The following policy titles were added (no policy linked): BRCA; Genetic Testing and Genetic Expression Profiling in Patients with Cutaneous Melanoma; Genetic Testing for Connective Tissue Disorders; Genetic Testing for Neurodegenerative Disorders; Lynch Syndrome; Minimal Residual Disease; Molecular Analysis for Gliomas; Molecular Testing of Pulmonary Specimens
1.2 (v4)	11/03/2022	Removed content from the policy table.
1.1 (v3)	10/31/2022	Article is active. A disclosure statement has been added to the beginning of the article.
1.0 (v2)	07/25/2022	Article has been taken offline until further notice.
0.0 (v1)	07/18/2022	First published.

Details

URL Name Genetic-Testing-Medical-Policies-Avalon