Genetic Testing for Oncology
L39667
Genetic testing to guide oncologic treatment is covered only when it will directly inform management for a patient with an established cancer diagnosis (or substantiated suspicion supported by clinical evaluation AND abnormal histologic/cytologic/flow cytometric results, with rare allowance for cell‑free testing if biopsy is contraindicated), and the test demonstrates analytic validity, clinical validity, clinical utility and actionability per ClinGen/NCCN/OncoKB or applicable NCD 90.2 (NCD 90.2 overrides for DNA‑only NGS of non‑hematologic malignancies). Tests lacking sufficient evidence (including DecisionDx‑Melanoma, DecisionDx‑SCC, UroVysion FISH, Colvera, PancraGEN/PancreaSeq) are not covered; the ordering provider must be the treating clinician who documents how results will affect care, obtains patient understanding/genetic counseling, and meets all LCD/NCD documentation and billing requirements (germline testing limited to one lifetime per beneficiary).