Genetic Testing for Hereditary Cancer – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare considers single-gene and known-mutation testing (including BRCA1/2 in specified scenarios) and multigene hereditary cancer panels medically necessary only for the specific personal-history, family-history, tumor-finding, or predictive-model score indications listed (e.g., early-onset, metastatic or multiple primaries, Lynch-associated cancers, pancreatic/prostate/neuroendocrine tumors, Ashkenazi ancestry); multi-gene panels (≥5 genes), RNA panels, and polygenic risk scores are unproven and not medically necessary for indications not listed. Coverage requires documentation such as a contemporaneous pedigree, evidence of personal/family cancer diagnoses and ages, relevant tumor testing results (e.g., pathogenic variants, MSI/MMR IHC), applicable predictive-model scores, and remains subject to member-specific benefit plans and federal/state mandates.

"Pre-test genetic counseling is strongly recommended in order to inform persons being tested about the advantages and limitations of the test as applied to a unique person."