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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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Reminder: Now Offering GIC POS and HMO Products


Genetic Testing Medical Policy Updated

New Medical Policy for Urine Drug Testing

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Payment Policy Update: Coverage of CPT 99211

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator