Genetic Testing 101
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What is Genetic Testing?
What are the Benefits of GT?
Provider Qualifications:
The ordering provider of a genetic test for a patient with an established diagnosis of cancer or substantiated suspicion of cancer must:
- Be the treating clinician who is responsible for the management of the patient’s cancer; and,
- Understand how the test result will impact the patient’s condition; and,
- Have presented this information to the patient eliciting patient understanding.
(See Code of Federal Regulations, Title 42, Volume 2, Chapter IV, Part 410.32(a)).
What is the billing criteria for GT?
What’s the OIG looking for?
Resources:
Billing and Coding: Molecular Pathology and Genetic Testing
cms.gov A58917
Medicare NCCI 2025 Coding Policy Manual Chapter 10
cms.gov Medicare NCCI 2025 Coding Policy Manual – Chapter 10
Medicare NCCI Policy Manual | CMS
cms.gov Medicare NCCI Policy Manual | CMS
L39365 – (LCD) Genetic Testing in Oncology: Specific Tests
DOJ Press Release – July 1, 2025
FCA: Dr. Mufti’s Case