Full sequence APC genetic testing is considered medically necessary only when it is not possible to determine the family mutation first.Īetna considers APC genetic testing experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established.Īetna considers DNA testing for CADASIL medically necessary for either of the following indications: The specific APC mutation should be identified in the affected first-degree relative with FAP prior to testing the member, if feasible. Members with first-degree relatives (i.e., siblings, parents, and offspring) diagnosed with familial adenomatous polyposis (FAP) or with a documented APC mutation.Members with a desmoid tumor, hepatoblastoma, or cribriform-morular variant of papillary thyroid cancer or.Members with greater than 10 colonic polyps or.See Appendix for List 1: Suspected Diagnoses.Īetna considers adenomatous polyposis coli (APC) genetic testing medically necessary for either of the following indications: After history, physical examination, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain, and one of the following diagnoses is suspected (this list is not all-inclusive) and.
The result of the test will directly impact the treatment being delivered to the member and.
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