MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L36159
Medicare considers genetic testing for inherited thrombophilias (F5 Factor V Leiden, F2 G20210A, MTHFR) non-covered in most circumstances; the only specific indicated population described is pregnant patients with a prior VTE associated with a transient risk factor who are not receiving anticoagulant prophylaxis. MTHFR genotyping is explicitly not indicated in any population, and F5/F2 testing is investigational for all other indications, though coverage may be considered in unusual cases where documented testing changes management; denials should be appealed with medical records and documentation of management change. Provider board qualification in hematology/oncology, hematopathology, or coagulation disorders is required to meet reasonable and necessary ordering 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..."