Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay

This policy covers Concert genetic testing—including chromosomal microarray, targeted molecular sequencing, methylation, deletion/duplication analyses, and multigene panels—for evaluation and diagnosis of multisystem inherited disorders, intellectual disability, developmental delay, autism spectrum disorder, and specified syndromes (e.g., Angelman, Prader‑Willi, Beckwith‑Wiedemann, Russell‑Silver, cystic fibrosis, CHARGE, Fanconi anemia, Fragile X) when clinical evaluation and standard laboratory/imaging tests are non‑diagnostic or when results would inform management or obviate further workup. Coverage is limited to the listed indications and required clinical criteria (isolated speech/language delay excluded), with numerous tests and CPT codes deemed investigational or non‑covered outside the specified scenarios and certain analyses (e.g., CMA, CFTR sequencing/polyT‑TG) restricted to defined clinical contexts.

"Genetic testing to establish or confirm a diagnosis in a patient with signs and/or symptoms of a genetic disorder when clinical evaluation and standard laboratory tests/imaging are non-diagnostic o..."