Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions

This policy covers genetic testing—including multigene panels, single‑gene sequencing, deletion/duplication analyses, and repeat‑expansion testing—to establish or confirm hereditary epilepsy, neurodegenerative, and neuromuscular diagnoses (e.g., epilepsy, SMA, Rett syndrome, CADASIL, familial Alzheimer disease, ALS, DMD, CMT, FSHD, Friedreich ataxia, Huntington) in patients with compatible signs/symptoms or relevant family history. Coverage is limited to cases where clinical evaluation and standard tests are non‑diagnostic or results would affect management (documentation of specified clinical criteria and exclusion of non‑genetic causes is required); many comprehensive panels and certain tests are considered investigational and not covered except as explicitly stated, and disorder‑specific or asymptomatic testing may be excluded.

"Genetic testing for hereditary epilepsy, neurodegenerative, or neuromuscular disorders to establish or confirm a diagnosis in patients with signs and/or symptoms of a genetic disorder when clinical..."