MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
L36400
Medicare considers genetic testing for thrombophilia generally non-covered, with MTHFR genotyping explicitly considered investigational and not covered in any scenario. A narrow exception exists for genetic testing of F5 (Factor V Leiden) and F2 (prothrombin G20210A) in pregnant patients with a prior personal VTE associated with a transient (non-recurrent) risk factor who are not receiving anticoagulant prophylaxis; other indications, asymptomatic screening, and testing of relatives are not covered. Claims for the limited Medicare pregnant population are typically denied but may be appealed with supporting medical records and documentation showing how test results changed anticoagulant management; ordering providers should document appropriate hematology/oncology or coagulation credentials.
"Genetic testing for F5 (Factor V Leiden) and F2 (prothrombin G20210A) is indicated for pregnant patients with a history of personal venous thromboembolism (VTE) associated with a non-recurrent (tra..."