Providers

Medical Policy Upcoming Updates

Notification Date: January 15, 2020

Below are the policies that are new or have been reviewed, along with the determination and summary of any changes.

Coverage Policies

Policy Title	Status	Effective Date	Determination	Summary of Change
Genetic and Pharmacogenetic Testing	Re-Reviewed	03/16/2020	Covered for some indications; investigative and therefore not covered for all other indications	Relevant Edits: IV. Pharmacogenetic testing for drug metabolism: Added a direct link to the FDA Tool - List of Cleared or Approved Companion Diagnostic Devices (In Vitro and Imaging Tools), therefore, the previous attachment listing these tests was removed. Single Gene Testing for Heritable Disease moved from a table within the policy to an attachment. Additional New Sections: V. Investigative and therefore NOT COVERED. List of investigative genetic tests not covered based on the current MCG Ambulatory Care Guidelines (ACGs). VI. MCG Guidelines States that Medica may reference MCG ACGs when no specific Medica policy exists.

Policy Title

Status

Effective Date

Determination

Summary of Change

Genetic and Pharmacogenetic Testing

Re-Reviewed

03/16/2020

Covered for some indications; investigative and therefore not covered for all other indications

Relevant Edits:

IV. Pharmacogenetic testing for drug metabolism:
- Added a direct link to the FDA Tool - List of Cleared or Approved Companion Diagnostic Devices (In Vitro and Imaging Tools), therefore, the previous attachment listing these tests was removed.
Single Gene Testing for Heritable Disease moved from a table within the policy to an attachment.

Additional New Sections:

V. Investigative and therefore NOT COVERED.
- List of investigative genetic tests not covered based on the current MCG Ambulatory Care Guidelines (ACGs).
VI. MCG Guidelines
- States that Medica may reference MCG ACGs when no specific Medica policy exists.

The updated clinical policies and guidelines above will be available as of their effective date, as noted. View policies and guidelines.

To request paper copies of a policy, please leave a message at the Medica Provider Literature Request Line: 1-800-458-5512, option 1, then option 8, then ext. 2-2355.

Where information conflicts with applicable state and/or federal law, Medica follows such applicable federal and/or state law.