Concert Genetic Testing: Hereditary Cancer Susceptibility

This policy covers germline genetic testing for hereditary cancer susceptibility—including single-gene, syndrome-specific or multi-gene panels, and targeted single-variant testing—when an individual’s personal cancer history or family history raises concern for an inherited cancer syndrome or when a known familial pathogenic/likely pathogenic (P/LP) variant exists. Coverage requires tests to be clinically warranted, limited to genes with established disease associations (panels must include BRCA1, BRCA2, EPCAM, MLH1, MSH2, MSH6, PMS2), is for members aged ≥18, and targeted germline testing is only covered for known familial P/LP variants or when somatic findings plus clinical/family history justify germline analysis; panels or assays without demonstrated analytic/clinical validity or that include non–disease-associated genes are not covered.

"Genetic testing for hereditary cancer susceptibility when an individual has personal medical history that raises suspicion for an inherited cancer syndrome."