RetiredCareSourcePolicy Cystic Fibrosis Carrier Testing-AR PASSE-AD-0989

Cystic Fibrosis Carrier Testing-AR PASSE-AD-0989

Administrative policy statement for Arkansas PASSE regarding cystic fibrosis carrier genetic testing, describing appropriateness, counseling recommendation, prior authorization, and intended population; policy was effective 11/01/2022 and later archived 04/30/2024.

Policy Summary

PayerCareSource

PolicyCystic Fibrosis Carrier Testing-AR PASSE-AD-0989

Policy CodePolicy Cystic Fibrosis Carrier Testing-AR PASSE-AD-0989

Change TypeArchived (policy removed) and prior addition of father/family history criteria

Effective DateNov 1, 2022

Next Review Date

Key ActionGenetic counseling is strongly suggested at the time of testing and should be provided by a qualified healthcare professional with relevant genetic expertise.

SourceLink

POLICY UPDATE CHANGES

Addition of policy section D. IV and V (carrier testing for fathers/prospective fathers and family history indications).

Policy archived and no longer active.

1Lifetime test frequency

Not requiredPrior Authorization

Archived 2024-04-30Policy status

Policy Overview

This administrative policy statement for Arkansas PASSE addresses cystic fibrosis carrier genetic testing. Cystic fibrosis is an autosomal recessive genetic disorder in which an abnormal gene must be inherited from both parents for a child to develop the disease; more than 10 million Americans are carriers and usually show no symptoms. Carrier screening can identify individuals who carry a defective CF gene and inform reproductive risk for current or future pregnancies.

Carrier testing is intended for individuals who are female and are pregnant or of reproductive age with the intent and potential to procreate and who have consented to testing; it is also appropriate for fathers or prospective fathers when the partner tests positive while pregnant or intending to become pregnant, and for individuals with a family history of cystic fibrosis.

Key policy facts

Effective date2022-11-01

Last review2022-07-20

Next review

Policy statusRETIRED (Archived 2024-04-30)

Policy numberCystic Fibrosis Carrier Testing-AR PASSE-AD-0989

Scope summaryAdministrative policy statement for Arkansas PASSE regarding cystic fibrosis carrier genetic testing, describing appropriateness, counseling recommendation, prior authorization, and intended population; policy was effective 11/01/2022 and later archived 04/30/2024.

Appropriate Use & Authorization

Appropriate Use Criteria

Carrier testing is appropriate when ALL of the following apply:

Appropriate Use Criteria - all

Pregnant or reproductive-age female: Individual is female and is pregnant or of reproductive age with intent and potential to procreate and has consented to the test.
Father or prospective father when partner positive: Individual is a father or prospective father when the partner tests positive while pregnant or intending to become pregnant.
Family history: Individual has a family history of cystic fibrosis.

Authorization and Frequency

Authorization and Frequency - all

Prior authorization is not required for cystic fibrosis genetic testing.
One-time testing: Cystic fibrosis testing should be performed once in a lifetime.
Genetic counseling suggested: Genetic counseling is strongly suggested at the time of testing by a healthcare professional with relevant genetic knowledge, education and training.

Actions for Providers

Documentation Required

Genetic counseling recommended

Genetic counseling is strongly suggested at the time of testing and should be provided by a healthcare professional with knowledge, education and training in the genetic issue relevant to cystic fibrosis. Counseling should be offered to help patients understand carrier status, reproductive implications, and testing limitations.

Prior Authorization

Prior authorization not required

Prior authorization is not required for cystic fibrosis genetic testing.

Billing Rule

One-time testing frequency

Cystic fibrosis carrier testing should be performed once in a lifetime (one-time testing frequency).

Definitions & Evidence

Definitions

CarrierAn individual who exhibits a genetic change that can result in a disease or disorder; usually has no signs but can pass the variation to offspring.

Prenatal TestingTesting done prior to birth to identify changes in genes or chromosomes in embryos or fetuses.

Autosomal RecessiveA trait or disorder requiring two copies of a mutation, one from each parent, to express the disorder.

Prenatal ScreeningA non-invasive blood analysis process to identify risk of fetal chromosome abnormalities or birth defects.

Evidence

Guideline sourcesReferences include ACMG, ACOG, Cystic Fibrosis Foundation, NSGC, MCG Health, Arkansas DHS lab fee schedule