Genetic Testing for Hereditary Colorectal and Uterine Cancer - Medicare Advantage

This policy covers germline and tumor genetic testing for hereditary colorectal and uterine cancer—including multigene NGS panels, single‑gene analyses, MSI‑H/dMMR and related molecular diagnostics—used to evaluate Lynch syndrome and other inherited colorectal/uterine cancer syndromes. Coverage is limited to indications meeting MolDX Program–approved technical assessments or FDA approval/clearance within labeling and specified clinical utility criteria (e.g., PREMM5 ≥2.5%, absence of a known pathogenic/likely pathogenic variant in a close relative, defined polyp/lesion thresholds), and Humana may apply supplemental LCD/NCD interpretations where CMS guidance is silent.

"Testing of multiple genes / multigene panel testing (Billing and Coding: MolDX: Testing of Multiple Genes; MolDX: Defining panel services in MolDX)"

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