Genetic Testing for Cardiovascular Disease

Medicare covers genetic testing for hereditary cardiovascular disease only when the patient has documented, disease-appropriate phenotyping and when ClinGen-evaluated gene–disease associations demonstrate actionable clinical validity (Moderate/Strong/Definitive) and meet specified evidence thresholds. The ordering provider must be the treating clinician who has counseled the patient, and germline cardiovascular gene testing is allowed only once per beneficiary’s lifetime; tests lacking analytical/clinical validity or those performed for asymptomatic screening, family-history-only, or solely for proband identification are not covered.

"Genetic testing is covered when the patient has rigorous, disease-appropriate phenotyping that establishes a clinical or suspected diagnosis and test results would directly impact management, docum..."

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