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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

July 2015

Genetic Testing Medical Policy Updated 


Harvard Pilgrim covers genetic testing for certain members when it is deemed medically necessary. Our Genetic Testing Medical Policy is effective immediately and details the coverage criteria, indicating the conditions that must be met in order for genetic tests to be considered medically necessary and identifying situations in which genetic testing is not covered.

Based on an ongoing review of the clinical literature to determine medical necessity, Harvard Pilgrim has updated this policy to identify a list of genetic tests that will not be covered due to a lack of evidence to support their clinical utility. Based on our review, genetic testing for the following conditions is not considered medically necessary:

  • Familial Alzheimer disease
  • Amyotrophic lateral sclerosis (ALS)
  • Age-related macular degeneration
  • Narcolepsy
  • Kabuki syndrome
  • Scoliosis
  • Stickler syndrome

For the complete information, including additional tests Harvard Pilgrim considers not medically necessary, please see the updated Genetic Testing Medical Policy available on our provider website.

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ICD-10 Information Available Online

Reminder: Now Offering GIC POS and HMO Products

CLINICIAN CORNER

Genetic Testing Medical Policy Updated

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Update: Outpatient Rehabilitative Therapies Policy

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Reminder: Naloxone Available Without Member Cost Sharing

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Specialty Pharmacy Program Updates

Medicare Quality Improvement: Reducing Preventable Readmissions

Diabetes Outreach Program for Medicare Advantage Members

OFFICE ASSISTANT

Payment Policy Update: Coverage of CPT 99211

Payment Policy Update: Counseling Risk Factor Reduction

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator