Genetic Testing for Diagnosis and Management of Mental Health
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This policy addresses coverage for genetic testing used to diagnose, predict risk of, or guide management (including medication selection/dosing) of mental health disorders for Capital Blue Cross members. It applies to commercial products administered by Capital Blue Cross and notes product-specific variations (e.g., FEP PPO).
No material clinical or coverage changes in this revision.
Coverage Determinations
Investigational / Not covered
Policy determination
Examples of panels considered investigational include Genecept Assay, STA2R test, the GeneSight Psychotropic panel, the Proove Opioid Risk assay, and the Mental Health DNA Insight panel
Not covered — investigational genetic tests for mental health
Policy-level coverage stance
Specific procedure codes for these tests are listed in the coding cross-reference as not covered.
Use of genetic testing to confirm a diagnosis of a mental health disorder in a symptomatic individual or to predict future risk of a mental health disorder in an asymptomatic individual is considered investigational by Capital BlueCross and is therefore not covered. The policy explicitly lists these uses as investigational and states there is insufficient evidence to support a general conclusion that such testing improves health outcomes.
Genetic testing intended to inform selection or dosing of psychiatric medications — including but not limited to selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors/serotonin–norepinephrine reuptake inhibitors (SNRIs/SNRIs), tricyclic antidepressants, and antipsychotics — is designated investigational and is not covered under this policy.
Genetic testing for specific mutations associated with mental health disorders is designated investigational and not covered. The policy cross-reference lists this investigational status as the basis for denying coverage for such tests.
Commercial genetic testing panels marketed for mental health applications — including but not limited to Genecept Assay, STA2R, GeneSight Psychotropic panel, Proove Opioid Risk assay, and the Mental Health DNA Insight panel — are considered investigational for all indications and are therefore not covered.
All indications addressed in this policy for genetic testing related to mental health disorders are labeled investigational and thus not covered. Providers should expect these services to be denied when billed under the procedure codes listed in the policy cross-reference.
Procedure and Billing Codes
| 0173U | proprietary procedure code listed |
| 0175U | proprietary procedure code listed |
| 0291U | proprietary procedure code listed |
| 0292U | proprietary procedure code listed |
| 0293U | proprietary procedure code listed |
| 0345U | proprietary procedure code listed |
| 0347U | proprietary procedure code listed |
| 0348U | proprietary procedure code listed |
| 0349U | proprietary procedure code listed |
| 0392U | proprietary procedure code listed |
Provider Guidance and Billing Impact
Check product-specific authorization
This policy applies only to certain Capital Blue Cross programs and products; providers must consult product-specific benefit materials or manuals (for example, FEP PPO refers to the FEP Medical Policy Manual) to determine authorization requirements for a member's plan.
- Verify member's product/program and benefit variation before submitting authorization requests.
- Refer to product-specific manuals (e.g., FEP Medical Policy Manual) when indicated.
Codes referenced as investigational/not covered
Numerous CPT and proprietary procedure codes are listed in the policy cross-reference as investigational or not covered; an investigational designation indicates these services are not covered under this policy.
- See policy coding cross-reference for specific codes identified as investigational or not covered.
Step therapy
No step therapy requirements are specified in this document.
Product variation note
Policy applicability may vary by product; providers should refer to product-specific benefit variations and manuals (for example, FEP PPO directs providers to the FEP Medical Policy Manual).
- Confirm applicability for the member's specific product before ordering or billing.
Coding and coverage note
The list of procedure codes in the policy may not be all-inclusive and identification of a code does not denote coverage; coverage is determined by the member's benefit information and contract terms.
- Check member benefit details to determine coverage and reimbursement eligibility.
Investigational — denial risk
Genetic testing for diagnosis and management of mental health disorders is considered investigational in all situations and therefore is a denial risk for coverage.
- Tests intended to confirm diagnosis, predict future risk, or to inform medication selection or dosing are investigational and not covered.
Codes likely to be denied
The policy lists specific procedure codes that are identified as not covered/investigational for genetic testing related to mental health disorders; claims billed with these codes are likely to be denied under this policy.
Investigational tests not covered
Genetic testing for mutations associated with mental health disorders is investigational and therefore not covered; providers should not expect coverage for these investigational tests.
- Commercial panels named in the policy (e.g., Genecept, GeneSight, Proove, Mental Health DNA Insight, IDgenetix-branded tests) are considered investigational and not covered.
Background and Rationale
Genetic variants have been associated with psychiatric disorder risk and with aspects of drug metabolism, treatment response, and adverse event risk. Commercial pharmacogenomic panels combine multiple genes to characterize drug–gene interactions, but the policy emphasizes that clinical utility requires direct evidence that using test results to guide management improves net health outcomes. Available evidence and methodological limitations for many panel-based tests have led Capital BlueCross to consider these tests investigational for diagnostic, predictive, and medication-guiding uses.
Definitions and Key Terms
Pharmacogenomic Testing and Medication Selection
Pharmacogenomic testing / genetic panels
Assessment requires direct evidence that test-guided management improves clinical outcomes (preferably randomized controlled trials)
Pharmacogenomic-guided medication selection
Clinical studies cited include randomized trials and guideline publications; policy requires direct evidence of improved outcomes to change investigational status
Policy Revision History
Policy reviewed with no material change to clinical policy statements (last review date recorded).
Policy effective date updated to 2024-07-01.
Consensus review performed; policy statement unchanged.
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