Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers WES and WGS for non-oncology genetic diagnosis when results are expected to directly affect medical management and ALL specified clinical criteria are met (nonspecific presentation not fitting a defined syndrome, ordered by an approved specialist—medical geneticist, neonatologist, neurologist, immunologist, or developmental pediatrician—and meeting listed phenotype criteria), prenatal WES is covered after uninformative CMA/karyotype with specified fetal findings/samples, and WGS is limited to cases where CMA/WES have not been performed or were nondiagnostic. Rapid/ultra‑rapid outpatient sequencing, whole transcriptome sequencing, and optical genome mapping are considered unproven/not medically necessary and WES/WGS are not covered for other non‑specified indications (e.g., fetal demise, PGT, cfDNA screening); testing must be ordered/interpreted by qualified providers, documented to change management, accompanied by pre/post‑test genetic counseling, performed in a CLIA‑regulated lab, and reanalysis is covered only after ≥18 months with new symptoms or data.