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February 2013

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Genetic Testing
Genetic Testing for Lynch Syndrome and Inherited Intestinal Polyposis Syndromes

Genetic testing for MMR gene mutations is considered medically necessary in the following patients:

  • Patients with endometrial cancer and one first-degree relative diagnosed with a Lynch-associated cancer, for the diagnosis of Lynch syndrome
  • CRC diagnosed with one or more first-degree relatives with an HNPCC-related tumor (colorectal, endometrial, stomach, ovarian, pancreas, bladder, ureter and renal pelvis, biliary tract, brain [usually glioblastoma as seen in Turcot syndrome], sebaceous bland adenomas and keratoacanthomas in Muir-Torre syndrome, and carcinoma of the small bowel), with one of the cancers being diagnosed at younger than age 50 years, OR CRC diagnosed in 2 or more first- or second-degree relatives with HNPCC-related tumor, regardless of age.

Experimental/Investigative Services Pathology/Laboratory
Proteomics-based Testing for the Evaluation of Ovarian (Adnexal) Masses

No coverage will be provided for all uses of the proteomics-based OVA1 and ROMA tests, including but not limited to the following as they are considered investigational:

  1. Preoperative evaluation of adnexal masses to triage for malignancy; or
  2. Screening for ovarian cancer; or
  3. Selecting patients for surgery for an adnexal mass; or
  4. Evaluation of patients with clinical or radiologic evidence of malignancy; or
  5. Evaluation of patients with nonspecific signs or symptoms suggesting possible malignancy; or
  6. Post-operative testing and monitoring to assess surgical outcome and/or to detect recurrent malignant disease following treatment.