Molecular Biomarker Testing for Noncancer Indications - MEDICAID - SOUTH CAROLINA

This policy covers molecular biomarker testing for noncancer indications—tests of genes, chromosomes, or proteins used for screening, diagnostic confirmation, or guiding treatment in individuals with inherited or acquired conditions (examples include inherited neurometabolic disorders such as Tay‑Sachs/GM2 gangliosidoses, prenatal maternal serum screening, cardiovascular risk markers, and APOL1 testing related to kidney donation). Major limitations/requirements include that abnormal prenatal serum screens are not definitive and require confirmatory invasive testing, certain assays (eg, ST2/Cardio IQ) are not eligible, coverage is contingent on acceptable clinical evidence, and testing must follow clinician evaluation with a three‑generation family history and involvement of credentialed genetics professionals.

"Molecular biomarker testing may be performed to analyze gene, chromosome or protein alterations in individuals with inherited disorders or acquired diseases."