Genetic Testing in Oncology: Specific Tests

Genetic testing in oncology is covered when the treating clinician has an established cancer diagnosis or a substantiated suspicion of cancer supported by a clinical evaluation plus abnormal histologic/cytologic/flow cytometric results, and when test results would directly affect patient management. UroVysion is specifically covered to clarify indeterminate bladder cytology in patients with persistent hematuria after complete evaluation and for surveillance of non‑muscle invasive bladder cancer assessing BCG response per specialty guidelines. Testing without diagnosis/suspicion, asymptomatic screening (including for relatives), and repeats of the same test on the same specimen are not reasonable and necessary; the ordering provider must document clinical utility and informed patient discussion.

"Genetic testing is reasonable and necessary when the provider has established a diagnosis of cancer or a substantiated suspicion of cancer based on both a clinical evaluation AND abnormal histologi..."