MolDX: Repeat Germline Testing

Medicare considers repeat testing of the same germline genetic content in the same beneficiary to be duplicative and not reasonable or necessary; any specific germline DNA/RNA test is limited to one unit of service per lifetime. Gene panels that include previously tested genes may be covered only if the remaining non-duplicative genes have documented established clinical utility, and providers must review prior records to justify non-duplicative testing.

"Germline DNA or RNA-based testing is covered for a Medicare beneficiary when the test investigates germline genetic content that has not previously been tested in that same beneficiary."

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