MolDX: Repeat Germline Testing

Medicare covers germline DNA- and RNA-based testing when it is reasonable and necessary and not duplicative of prior testing in the same beneficiary. Gene panels that include previously tested content may be allowed only if the remaining non-duplicative components have documented, established clinical utility; any specific germline test is limited to one unit of service per lifetime. Providers must verify and document prior testing and medical necessity to avoid billing for duplicative services.

"Germline DNA- or RNA-based testing of a Medicare beneficiary is covered when the test is reasonable and necessary and is not duplicative of prior germline testing in the same beneficiary."

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