BRCA1 and BRCA2 Genetic Testing

Medicare covers germline BRCA1/BRCA2 testing for Medicare beneficiaries who have a personal history of BRCA-related cancers (breast, epithelial ovarian/fallopian tube/primary peritoneal, pancreatic, or prostate) when specific risk criteria are met (age at diagnosis, family history, tumor histology such as triple-negative, Ashkenazi Jewish ancestry, or known familial BRCA mutation). Multigene NGS panels may be covered when NCD 90.2 criteria are satisfied and all panel genes are relevant to the individual’s personal and family history. Testing of asymptomatic/unaffected individuals, routine population screening, individuals under age 18, multigene panels with irrelevant genes, and certain repeat testing (e.g., solely prior to Lynparza) are not covered; documentation including medical records, family history details, tumor profiling reports (if applicable), and ABN when applicable must be maintained.

"Personal history of epithelial ovarian carcinoma (includes fallopian tube and primary peritoneal cancers) is covered for BRCA1/BRCA2 germline testing."