Genetic Testing in Oncology: Specific Tests

Medicare covers genetic testing in oncology when a treating provider has established a cancer diagnosis or a substantiated suspicion of cancer (requiring clinical evaluation plus abnormal histologic, cytologic, or flow cytometric results) and the test will directly impact patient management. UroVysion is specifically covered to clarify indeterminate urine cytology in patients with persistent hematuria and for surveillance of non‑muscle invasive bladder cancer after BCG when performed in alignment with specialty society guidelines; genetic testing for asymptomatic screening, repeats on the same genetic material, tests not ordered by the treating provider, and certain named panel tests are not considered reasonable and necessary. Documentation must show the clinical evaluation and abnormal pathology results, guideline-aligned diagnostic procedures where required, that the ordering provider is the treating clinician, and that the patient was informed.

"Genetic testing is reasonable and necessary when the provider has either established a diagnosis of cancer or has a substantiated suspicion of cancer, defined by both a clinical evaluation and abno..."