Some 10% of cancers are associated with genetic inheritance, including the BRCA mutations.
How does one qualify for genetic testing for pancreatic cancer?
Genetic testing on BRCA mutations for pancreatic cancer would be considered medically necessary if the person has a personal history of epithelial ovarian, fallopian tube, or primary peritoneal cancer; male breast cancer; pancreatic cancer or prostate cancer with Gleason score 7 at any age; and/or pancreatic cancer with Ashkenazi Jewish ancestry. Otherwise, the claim would likely be denied.
When is genetic testing medically necessary?
Genetic testing to detect BRCA BRCA1 and or BRCA2 mutations and or large genomic rearrangements is considered medically necessary when all of the criteria in Table 1 are met. These criteria include: (1) individuals with pancreatic adenocarcinoma, (2) a personal or family history of breast, ovarian, tubal, or peritoneal cancer that suggests an inherited cancer susceptibility as determined by a validated BRCA1 or BRCA2 mutation assessment tool, and (3) tumor agnostic genetic testing indications may also apply, depending on the clinical scenario.
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