MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L36155
Medicare considers genetic testing for F5 (Factor V Leiden) and F2 (G20210A) covered only for pregnant patients with a prior VTE associated with a transient (non‑recurrent) risk factor who are not on anticoagulant prophylaxis, and when results would change antenatal management (e.g., identification of FVL or F2 homozygosity or compound heterozygosity). Testing for MTHFR is not covered in any population and is investigational. Testing outside the specified pregnant scenarios is non‑covered or investigational, claims will generally deny but may be appealed with supporting medical records and documentation of how testing altered anticoagulant prophylaxis; provider credentialing in hematology/coagulation is required to meet reasonable‑and‑necessary criteria.
"Genetic testing for F5 (Factor V Leiden) and F2 (G20210A) is indicated for pregnant patients with a personal history of venous thromboembolism (VTE) that was associated with a non-recurrent (transi..."