Genetic Testing for Cardiovascular Disease

Medicare coverage for genetic testing for hereditary cardiovascular disease requires documented, disease-appropriate phenotyping demonstrating that test results would directly affect patient management, and ClinGen-evaluated gene–disease associations that meet specified actionability and clinical validity thresholds (Moderate/Strong/Definitive and not disputed). Tests lacking established analytical/clinical validity or utility, tests in asymptomatic patients or based solely on family history or proband identification, and tests without the required documentation are not covered; germline cardiovascular gene testing is limited to one lifetime per beneficiary.

"Genetic testing is medically reasonable and necessary when the patient has rigorous, disease-appropriate phenotyping establishing a clinical or suspected diagnosis for which the genetic test result..."

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