Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - SOUTH CAROLINA

This policy covers genetic testing to assist in diagnosing inherited conditions, including inherited blood and coagulation disorders, metabolic disorders (e.g., glycogen storage disease type I), and a range of neurologic and neurodegenerative syndromes such as cerebellar ataxias (including adult-onset CANVAS and DRPLA), intellectual disability, movement disorders, and related presentations. Testing is intended to confirm diagnoses in symptomatic individuals for inherited (not acquired) causes and is subject to coverage limitations and member-specific requirements (see the Coverage Limitations section and the member’s benefit document), with final determination guided by the reviewing medical director.

"For establishing a disease-causing variant: documentation of the individual's confirmed diagnosis"

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