MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)

Genetic testing for inherited thrombophilias (F5/FVL, F2 G20210A, MTHFR) is generally non-covered; the only scenario with potential indication is testing F5 and F2 in pregnant patients with a prior VTE tied to a transient risk factor who are not on anticoagulant prophylaxis, or pregnant patients with a family history when results would change antenatal management. MTHFR genotyping is not supported and is not a Medicare benefit; screening asymptomatic individuals (including relatives) is non-covered, claims for the limited Medicare pregnant population are routinely denied but may be appealed with supporting medical records, and ordering providers must document appropriate hematology/coagulation certification.

"Genetic testing for Factor V Leiden (F5) and prothrombin G20210A (F2) is indicated for pregnant patients with a personal history of venous thromboembolism (VTE) associated with a non-recurrent (tra..."