MolDX: Repeat Germline Testing

This contractor considers repeat germline DNA/RNA testing that duplicates previously tested genetic content in the same Medicare beneficiary not reasonable and not covered. Coverage is allowed for non-duplicative germline testing (including gene panels) when remaining components have documented clinical utility, and any specific germline test is limited to one unit of service per beneficiary per lifetime; providers must document prior testing and clinical utility to support medical necessity.

"Germline DNA or RNA-based testing is covered when it does not duplicate previously tested germline genetic content in the same Medicare beneficiary."

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