MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L35984
Medicare considers genetic testing for inherited thrombophilias generally non‑covered; the main covered indication is testing for F5 (Factor V Leiden) and F2 (prothrombin G20210A) in pregnant patients with a prior VTE associated with a transient (non‑recurrent) risk factor who are not receiving anticoagulant prophylaxis, to inform antenatal prophylaxis. MTHFR genotyping is investigational and not covered in any scenario, screening of asymptomatic individuals (including relatives) is not covered, and most other indications for F5/F2 testing are investigational though individual denied claims may be appealed with supporting medical records and documentation of management change; provider board certification in relevant hematology/coagulation specialties is required to meet reasonable and necessary criteria.
"Genetic testing for Factor V Leiden (F5) and prothrombin G20210A (F2) is indicated for pregnant patients with a history of personal venous thromboembolism (VTE) associated with a non-recurrent (tra..."