ModifiedCentenePolicy N/A

CONCERT GENETIC TESTING: CARDIAC DISORDERS

Policy governing genetic testing for hereditary and other cardiac disorders (cardiomyopathy, arrhythmia, congenital heart defects, cholesterol disorders, and post-transplant rejection assessment) and intended for providers ordering or interpreting these tests.

Policy Summary

PayerCentene

PolicyCONCERT GENETIC TESTING: CARDIAC DISORDERS

Policy CodePolicy N/A

Change TypeMultiple clinical, operational, and coding updates (material)

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and provide clinical documentation (ECG, imaging, family history or autopsy) demonstrating that the member meets the specific panel criteria before ordering multigene panel testing.

SourceLink

POLICY UPDATE CHANGES

Updated many clinical criteria wording (e.g., changed 'sudden unexplained cardiac death' to 'sudden cardiac death or sudden unexplained death' across multiple panels and adjusted age thresholds and other specification details).

Added new sections for Post Heart Transplant Gene Expression Panels for Rejection Risk via Tissue and updated ISHLT guidance citations for peripheral blood gene expression testing.

Familial Hypercholesterolemia (FH) criteria and background were updated to align with contemporary guidance and to remove requirement of definitive genetic diagnosis prior to medication eligibility.

Default frequency of coverage for routine post-transplant monitoring adopted as once every 12 months absent specific guideline regimen.

Removed panel testing note for Restrictive Cardiomyopathy Panels as investigational.

1-1.2%CHD prevalence

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Cardiac phenotypes covered

81439Example cardiomyopathy CPT

12 moPost-transplant default frequency

0493UProspera (dd-cfDNA) added

Coverage Criteria for Cardiac Genetic Testing

Coverage Decision Logic

ALL of the following

Member meets diagnostic criteria for ARVC/ACM defined by current Task Force/consensus guidance (eg, one major OR two minor criteria from different categories).
Clinical documentation must include imaging reports (echo, MRI, RV angiography if performed), ECG findings, Holter/event monitor results, endomyocardial biopsy results (if available), and relevant family history or autopsy reports.

Prior Authorization

Prior Authorization and Coding

Prior authorization is required for panel‑based cardiac genetic tests (including but not limited to CPT 81413, 81414, 81439, 0237U) and for post‑transplant monitoring tests (eg, donor‑derived cell‑free DNA codes). Inclusion of a code in this policy is informational and does not guarantee coverage; providers must obtain prior authorization and verify member eligibility and benefits.

Documentation Required

Required Clinical Documentation for Review

Providers must submit the following clinical documentation with prior authorization requests: detailed clinical history and indication (symptoms such as syncope, documented VT/VF, aborted sudden cardiac arrest), baseline and provocative ECGs (with QTc and Schwartz score when applicable), echocardiogram and/or cardiac MRI reports with measurements, Holter/event monitor summaries, results of endomyocardial biopsy (if performed), family history including ages and causes of SCD/SUD with autopsy findings when available, and documentation of prior non‑genetic evaluations that rule out reversible causes (eg, ischemia, electrolyte abnormalities, drug effects). For FH testing, submit at least two LDL‑C measurements (or acceptable surrogates) after lifestyle modification or documentation of pre‑treatment LDL‑C when available, and family history of hypercholesterolemia or premature CAD per guideline thresholds.

Note

Testing and Interpretation Requirements

Testing and interpretation should be performed or overseen by clinicians with cardiac genetics expertise (eg, board‑certified medical geneticists, genetic counselors with cardiovascular experience, or cardiologists with documented genetic training). Complex cases (eg, variants of uncertain significance, discrepant phenotype/genotype findings, disputed gene validity) should involve a multidisciplinary cardiac genetics team for interpretation and management recommendations.

Note

Gene Validity and Brugada Syndrome Testing

For Brugada syndrome: testing should focus on validated disease genes (SCN5A). Do not routinely include genes with disputed or refuted ClinGen gene–disease validity in diagnostic panels for BrS. Clinical diagnosis should be established (Type 1 ECG pattern present or provoked and alternative phenocopies excluded) prior to broad genetic testing.

Prior Authorization

LQTS Pre‑Test Probability Requirement

Long QT Syndrome (LQTS) panel testing requires an assessment of pre‑test probability. Genetic testing is medically necessary for index patients with high probability (eg, Schwartz score ≥3.5 or cardiologist‑documented strong clinical suspicion based on history, family history, and ECG phenotype). In intermediate probability (Schwartz 1.5–3.0), limit testing to established LQTS genes; avoid genes with limited, disputed, or refuted evidence. Providers must document the Schwartz score or equivalent clinical rationale when requesting LQTS panel testing.

Documentation Required

Known Familial Variant Workflow

Known familial variant (cascade) testing workflow: requests for targeted testing of a known pathogenic or likely pathogenic familial variant should follow the policy 'Genetic Testing: General Approach to Genetic and Molecular Testing.' Prior authorization is still required but the review is expedited when the familial pathogenic/likely pathogenic variant and the relationship to the proband are documented.

Billing Rule

Post‑Transplant Monitoring and Frequency

For post‑heart transplant monitoring: Allomap (gene expression profiling) and donor‑derived cell‑free DNA (dd‑cfDNA) tests may have specific coverage windows and frequency limits. ISHLT guidance supports GEP in low‑risk adults between 2 months and 5 years post‑transplant to reduce EMB frequency. In the absence of clear guideline recommendations for routine screening frequency, a default coverage frequency of once every 12 months for routine monitoring may be applied unless medical necessity for more frequent testing is documented. Prior authorization is required for dd‑cfDNA testing and documentation should include transplant date, prior rejection history, concurrent immunosuppression regimen, and indication for increased monitoring.

Billing Rule

Coding Inclusion Is Not Coverage Guarantee

Coding and billing notes: CPT/HCPCS/ICD codes cited in this policy are examples for administrative use only. Inclusion of a code does not guarantee payment. Providers must verify benefits, submit prior authorization, and follow payer coding guidance. Labs should use the appropriate panel code when a panel is performed and include test methodology and gene list in the submission.

CPT/HCPCS code inclusion in this policy is informational only and is not a guarantee of coverage.
Use the appropriate panel CPT code when a multigene panel is performed and ensure the lab's reported gene list matches the requested panel.

Documentation Required

FH Testing Prerequisites and Gene Content

Familial hypercholesterolemia (FH) testing prerequisites: genetic testing is appropriate when clinical index of suspicion meets guideline thresholds (eg, children with persistent LDL‑C ≥160 mg/dL or adults with LDL‑C ≥190 mg/dL without secondary causes plus family history, or very high LDL‑C levels even without family history). Panels should include at minimum LDLR, APOB, and PCSK9; expanded panels may include LDLRAP1, LIPA, ABCG5, ABCG8, and APOE where clinically indicated. Document LDL measurements (two or more), assessment for secondary causes, and family history with ages of CAD events.

Provider Requirements and Operational Guidance

Prior Authorization

Confirm prior authorization and up‑to‑date coding

Verify whether prior authorization is required and confirm the current, payer‑recognized CPT/HCPCS code for the specific panel before ordering or billing genetic panels.

Reference the Concert Platform or payer resources for registered tests and updated coding guidance prior to claim submission.

Prior Authorization

Prior authorization required for multigene panel CPT/HCPCS codes

Obtain prior authorization when billing the listed multigene panel CPT/HCPCS codes (examples include 81439, 0237U, 81413, 81414); include documentation demonstrating the patient meets the panel‑specific clinical criteria.

Include ECGs, imaging measurements, autopsy findings, or family history as specified by the panel criteria.

Prior Authorization

Provide Schwartz score and ECG/QTc for LQTS panel requests

Coding and Billing Reference

Comprehensive Cardiomyopathy Panels - Common CPT CodesCPT

81439

Comprehensive cardiomyopathy panels (example common CPT code)

Comprehensive Arrhythmia Panels - Common CPT CodesCPT

81413	Comprehensive arrhythmia panels (example CPT)
81414	Comprehensive arrhythmia panels (example CPT)
0237U	Genomic Unity Cardiac Ion Channelopathies Analysis (example HCPCS/PLA)

Other Panel CPT Codes (LQTS, SQTS, Brugada, CPVT examples)CPT

81403	Panel-related CPT (example for LQTS, SQTS, CPVT)
81406	Panel-related CPT (example)
81407	Panel-related CPT (example)
81479	Unlisted molecular pathology procedure (example)
81404	SCN5A variant analysis example CPT
81405	CPVT panel example CPT
81408	CPVT panel example CPT

Common ICD-10 Codes referenced across panelsICD-10

I42.0	Dilated cardiomyopathy
I42.1	Obstructive hypertrophic cardiomyopathy
I42.2	Other hypertrophic cardiomyopathy
I42.5	Other restrictive cardiomyopathy
I42.8	Other cardiomyopathies
I42.9	Cardiomyopathy, unspecified
I45.81	Long QT syndrome (arrhythmia code referenced)
I49.8	Other specified cardiac arrhythmias
Z13.71	Genetic disease carrier screening and testing
Z82.41	Family history of sudden cardiac death

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Covered CPT/HCPCS Codes (panels and tests)mixedCovered

81439	Comprehensive cardiomyopathy panel / multigene cardiomyopathy testing
0237U	Comprehensive arrhythmia panel (HCPCS listed in policy)
81413	Multigene sequencing panel (arrhythmia/cardiac genes) - as listed
81414	Multigene sequencing panel (arrhythmia/cardiac genes) - as listed
81403	Long QT / short QT multigene panel (example codes listed)
81405	Multigene panel - arrhythmia/cardiac related
81406	Multigene panel - arrhythmia/cardiac related
81407	Multigene panel - arrhythmia/cardiac related
81408	Multigene panel - arrhythmia/cardiac related
81479	Unlisted molecular pathology procedure

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Associated ICD-10 Diagnosis Codes referencedICD-10

I49.8	Other specified cardiac arrhythmias
Z13.71	Encounter for screening for genetic and chromosomal anomalies
Z82.41	Family history of sudden cardiac death
Z82.49	Family history of other diseases of the circulatory system
Z84.81	Family history of sudden infant death syndrome
Z84.89	Family history of other specified conditions
Z94.1	Heart transplant status
Z48.21	Encounter for aftercare following heart transplant
E78	Disorders of lipoprotein metabolism and other lipidemias
E78.01	Familial hypercholesterolemia

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Removed CPT code referencesCPT

81404

Removed from some panel criteria (was previously listed)

Covered/Referenced Genetic Testing Codesmixed

affected codes

Panel and targeted genetic testing CPT/HCPCS codes referenced elsewhere in policy (not enumerated in this window).

Policy Reference Table — donor-derived cfDNAHCPCSCovered

0493U

Prospera (Natera) donor-derived cell-free DNA

Prevalence of CHD

PrevalenceCongenital heart defects (CHDs) affect 1–1.2% of live births

NatureStructural heart defects present at birth; may have genetic or environmental causes

Clinical relevanceIdentifying genetic cause aids recurrence risk assessment, extracardiac evaluation, developmental risk assessment, and prognosis

HCM wall thickness thresholds

Adult diagnostic thresholdMaximal myocardial wall thickness ≥15 mm on echocardiogram or cardiac MRI

Background, Definitions, and Rationale

Hereditary arrhythmias and cardiomyopathies are typically diagnosed clinically using phenotype, family history, ECG, and cardiac imaging. Identification of a pathogenic or likely pathogenic variant can confirm a diagnosis and enable cascade testing of at-risk relatives. Genetic testing is most informative when ordered and interpreted by clinicians experienced in cardiac genetics and used in the context of the patient's clinical features and family history. Gene expression profiling and donor-derived cell-free DNA are emerging tools for post‑transplant surveillance and may be appropriate in specified transplant settings.

Definition — Congenital heart defects (CHDs)

Definition: CHD prevalenceCongenital heart defects (CHDs) affect approximately 1–1.2% of live births

Definition: CHD descriptionStructural heart defects present at birth; causes may be genetic or environmental

Clinical importanceIdentifying genetic causes informs recurrence risk, extracardiac evaluation, developmental assessment, and prognosis

Definition — Cascade testing

Policy Changes and Revision Notes

2024-04-24criteria_revision

Removed requirement that a definitive genetic diagnosis be present for medication eligibility in Familial Hypercholesterolemia (FH) criteria and made minor rewording and coding/reference updates across panels (V2.2024).

2023-03-23policy_creation

Policy developed and approved; updated title to V1.2024 and revised multiple panel criteria wording (e.g., changed 'sudden unexplained cardiac death' wording, adjusted age thresholds, removed CPT 81404 from RCM), and updated background and references.

2024-10-23criteria_revision

Policy Summary

PayerCentene

PolicyCONCERT GENETIC TESTING: CARDIAC DISORDERS

Policy CodePolicy N/A

Change TypeMultiple clinical, operational, and coding updates (material)

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

When requesting LQTS panel testing, prior authorization requests should state the clinical pre‑test probability (Schwartz score) and include ECG/QTc values used to support testing.

Provide resting ECG QTc measurements and any provocative testing results referenced in the clinical assessment.

Prior Authorization

PA required—document that panel criteria are met

Prior authorization is required for ordering multigene or panel‑based genetic tests per the policy; the request must document that the member meets the specific panel medical‑necessity criteria.

Document how the patient's phenotype or family history satisfies the panel's stated indications.

Prior Authorization

PA and documentation for dd‑cfDNA (e.g., Prospera 0493U)

Requests for donor‑derived cell‑free DNA tests (for example, Prospera, HCPCS 0493U) are included in the policy reference table; coverage is subject to the policy's monitoring frequency and applicable criteria.

Include test name/code and indication in chart documentation when requesting dd‑cfDNA monitoring.

Documentation Required

Document prior lipid measurements and lifestyle/therapy for FH panels

For familial hypercholesterolemia testing, document prior LDL‑C measurements and that intensive lifestyle modification was attempted; list prior lipid‑lowering therapies when relevant.

Provide two or more LDL‑C measurements, including values after lifestyle modification, and note exclusion of secondary causes.

Note

Known familial‑variant testing workflow moved to consolidated policy

Known familial variant (targeted) testing criteria have been moved to the consolidated policy 'Genetic Testing: General Approach to Genetic and Molecular Testing'; follow that workflow for known‑variant analysis.

Submit targeted testing requests under the consolidated policy workflow rather than panel criteria in this policy.

Documentation Required

Consult a cardiac genetics expert for test selection and interpretation

Testing decisions and interpretation should be performed by, or in consultation with, an expert in cardiac genetics; include expert input in the medical record when available.

Document consultation or the responsible cardiac genetics clinician in the chart to support testing decisions.

Documentation Required

Attach diagnostic imaging, autopsy, and family‑history evidence with panel requests

Provide supporting diagnostic evidence with panel requests—examples include echocardiogram or cardiac MRI measurements, autopsy findings, and relevant family history of sudden cardiac death or unexplained death.

Attach imaging reports (echo/MRI) showing numeric thresholds cited in the policy where applicable.

Documentation Required

Record phenotype metrics (e.g., LVEF <50% for DCM; LDL‑C values for FH)

Document phenotype‑specific evidence to justify testing: for DCM include left ventricular enlargement and systolic dysfunction (LVEF <50%); for FH include documented LDL‑C values per policy thresholds.

For DCM, include echo/MRI reports showing LV enlargement and an EF <50%.
For FH, include two or more LDL‑C measurements and note evaluation for secondary causes.

Documentation Required

Support testing with phenotype and family‑history documentation

Ensure documentation supports clinical phenotype and pertinent family history (for example, LDL‑C or total cholesterol values for FH and family history of premature CAD) when requesting genetic testing.

If LDL‑C unavailable, provide total cholesterol values that correspond to LDL‑C thresholds per policy guidance.

Documentation Required

Include dd‑cfDNA test code and indication in documentation (e.g., 0493U)

When requesting donor‑derived cfDNA testing (e.g., Prospera 0493U), include the test code and indication in the chart and reference the policy's Provider/Policy Reference Table entry.

Document timing relative to transplant and the clinical reason for monitoring.

Billing Rule

Coding listed in policy is informational only — confirm coverage separately

Inclusion or exclusion of CPT/HCPCS codes in this policy does not guarantee coverage; verify current coding guidance and payer coverage before billing.

Use the Concert Platform and payer resources to confirm registered tests and up‑to‑date coding.

Denial Risk

Do not order comprehensive cardiomyopathy panels outside specified indications (denial risk)

Comprehensive cardiomyopathy panels (CPT 81439) are investigational for indications not listed in the policy; ordering such panels outside specified criteria may result in denial.

Use phenotype‑targeted panels recommended by guidelines rather than large unfocused cardiomyopathy panels when indications are not met.

Denial Risk

Do not order comprehensive arrhythmia panels outside policy criteria

Comprehensive arrhythmia panels (e.g., 0237U, 81413, 81414) are investigational for indications not specified in the policy; ordering panels outside those indications may be denied.

Confirm the patient meets the policy’s arrhythmia panel criteria before submitting authorization/billing.

Denial Risk

Restrict Brugada testing to clinically validated genes (avoid disputed ClinGen genes)

For Brugada syndrome, report only genes with established gene‑disease validity (SCN5A is the primary validated gene); reporting genes with disputed ClinGen validity may be a reason for noncoverage or denial.

Exclude genes with disputed ClinGen validity from diagnostic reports per policy guidance.

Denial Risk

Non‑adherence to revised panel criteria may lead to denial

Requests that do not meet the revised panel‑specific criteria, including updated wording and age thresholds, may be denied—ensure all eligibility elements and age thresholds are documented.

Review the updated panel criteria and age thresholds in the policy before submitting requests.

Billing Rule

Default post‑transplant monitoring frequency: once every 12 months

For routine post‑transplant monitoring, coverage will default to once every 12 months unless a specific evidence‑based guideline recommends a different regimen; requests for more frequent routine monitoring should reference guideline‑based justification.

Document guideline citation or clinical rationale if requesting monitoring more frequently than 12 months.

Pediatric thresholdZ-score ≥2 (body surface area–adjusted) in children

Contextual noteWall thickness 13–14 mm may be diagnostic in family members or with a positive genetic test

Dilated cardiomyopathy systolic function threshold

Systolic dysfunction thresholdLeft ventricular ejection fraction (LVEF) <50%

Diagnostic featuresDCM established when LV enlargement and systolic dysfunction are both present

Measurement methodsEF estimated by 2D echocardiogram, cardiac MRI, or left ventricular angiogram

Arrhythmogenic RVEDV/BSA thresholds

Male (major) RVEDV/BSA>110 mL/m2 (major)

Male (minor) RVEDV/BSA100–110 mL/m2 (minor)

Female thresholds>100 mL/m2 (major); 90–100 mL/m2 (minor)

QTc thresholds for testing — LQTS and SQTS

LQTS QTc cutoffsProlonged QTc: >480 ms in adults; >460 ms in prepubertal children

Testing contextConfirm prolonged QTc on resting ECG and/or provocative testing; exclude non-genetic causes

SQTS QTc cutoffShort QT diagnostic QTc ≤330 ms

Short QT diagnostic score and QTc thresholds

Diagnostic QTc cutoffQTc ≤330 ms is diagnostic for Short QT Syndrome (SQTS)

SQTS diagnostic scoreHigh-probability SQTS: score ≥4 points (score card awards up to 3 points for QTc ≤330 ms plus other criteria)

Testing recommendationMolecular testing recommended for definitive genes when diagnostic criteria or SQTS score ≥4 are met

DCM systolic dysfunction threshold

DCM LVEF thresholdLeft ventricular ejection fraction (LVEF) <50%

Supporting diagnostic featureRequires both LV enlargement and systolic dysfunction to establish DCM

Measurement guidanceEF commonly estimated by echocardiogram or cardiac MRI

Familial hypercholesterolemia (FH) lipid thresholds

Children LDL-C thresholdPersistent LDL-C ≥160 mg/dL (two or more measurements, after lifestyle modification) in children prompts FH testing

Adult LDL-C thresholdPersistent LDL-C ≥190 mg/dL (two or more measurements, after lifestyle modification) in adults prompts FH testing

Higher-threshold indicationAdults with LDL-C ≥250 mg/dL may be considered for testing even without family history

Total cholesterol thresholds corresponding to LDL-C

Total cholesterol equivalentsTotal cholesterol ≥320, 260, and 230 mg/dL correspond approximately to LDL-C ≥250, 190, and 160 mg/dL, respectively

Use caseApply when LDL-C values are unavailable (use two or more measurements and assess after lifestyle modification)

ConsiderationsRule out secondary causes (hypothyroidism, diabetes, renal disease, nephrotic syndrome, liver disease, medications)

HCM imaging wall thickness diagnostic criteria

Adult HCM imaging thresholdMaximal end-diastolic wall thickness ≥15 mm on 2D echocardiography or CMR (in absence of another cause)

Borderline diagnostic valuesWall thickness 13–14 mm may be diagnostic in family members of a patient with HCM or when combined with a positive genetic test

Pediatric criteriaUse BSA-adjusted z-score ≥2 for children due to growth and body size considerations

Cascade testingTesting of asymptomatic family members after identification of a pathogenic or likely pathogenic variant in an affected relative

PurposeEnables identification of at-risk relatives who may benefit from surveillance or interventions

ApplicationRecommended when a pathogenic variant is identified in an index case across cardiomyopathy, arrhythmia, or FH panels

Definition — LVH criteria for HCM testing

LVH definition for HCM testingUnexplained left ventricular hypertrophy: myocardial wall thickness ≥15 mm in adults or z-score ≥2 in children on echo or cardiac MRI

ContextUse when no other cardiac, systemic, or metabolic cause explains hypertrophy

Panel implicationMeets indication for HCM multigene panel when unexplained LVH present

Definition — DCM diagnostic features

DCM diagnostic featuresLeft ventricular enlargement plus systolic dysfunction (e.g., LVEF <50%) with non-genetic causes ruled out

RequirementBoth LV enlargement and systolic dysfunction must be present to establish DCM diagnosis

Testing implicationMeets indication for DCM multigene panel when criteria fulfilled

Definition — Dilated cardiomyopathy (DCM) summary

DCM summaryDilated cardiomyopathy is established when left ventricular enlargement and systolic dysfunction coexist; systolic dysfunction commonly defined as LVEF <50%

MeasurementEF commonly estimated from 2D echo or cardiac MRI; can also use left ventricular angiogram

Clinical noteRule out secondary causes (ischemia, valvular disease, toxins, thyroid disease, infections, severe hypertension) before attributing to genetic DCM

Definition — Schwartz score for LQTS

Schwartz score purposeDiagnostic scoring system for LQTS that stratifies pre-test probability to guide testing decisions

Probability categoriesLow ≤1; Intermediate 1.5–3; High ≥3.5

Testing implicationHigh-probability patients (Schwartz ≥3.5) should be offered molecular genetic testing for definitive LQTS genes

Definition — LDL-C equivalence for FH when LDL-C unavailable

LDL-C equivalenceWhen LDL-C unavailable, total cholesterol ≥320, 260, and 230 mg/dL correspond to LDL-C ≥250, 190, and 160 mg/dL, respectively

Measurement requirementTwo or more total cholesterol (or LDL-C) measurements recommended, including assessment after lifestyle modification

ExclusionsExclude secondary causes (hypothyroidism, diabetes, renal disease, nephrotic syndrome, liver disease, medications)

Definition — Gene Expression Profiling (GEP)

GEP (peripheral blood)Gene Expression Profiling (e.g., AlloMap) of peripheral blood can identify low risk of acute cellular rejection in adult heart transplant recipients 2 months to 5 years post-transplant (ISHLT 2022)

GEP (tissue)Tissue-based GEP (e.g., Molecular Microscope, MMDx) assesses rejection-associated gene transcripts in allograft tissue and can discriminate T-cell vs antibody-mediated rejection

Availability noteTissue-based GEP may not be widely available outside North America and is not routine everywhere

Definition — Sudden unexplained death (SUDS)

SUDS definition updateTerm updated to 'Sudden unexplained death (SUDS)' with language change to use 'unexplained sudden cardiac arrest' in relevant criteria

ContextApplied across panels and definitions to clarify postmortem and clinical events referencing sudden unexplained death or arrest

ImplicationUsed in family history and postmortem indications for genetic testing in several panel criteria

Definition — HCM imaging diagnostic criteria

Adult HCM imaging criteriaMaximal end-diastolic wall thickness ≥15 mm establishes HCM in adults (absent another cause)

Borderline valuesWall thickness 13–14 mm may be diagnostic in family members or with a positive genetic test

Pediatric criteriaUse BSA-adjusted z-score ≥2 for children due to growth considerations

Semi-annual review with multiple wording and specification changes across arrhythmia and cardiomyopathy panels including clarifications to Brugada, LQTS, and Short QT criteria and removal of some CPT code listings (revision date cited as 10/23 in Concert Notes).

2024-11-24reference_update

Added Wilde et al. 2022 EHRA/HRS/APHRS/LAHRS expert consensus reference for LQTS and updated rationale and references across the policy (noted in Concert Note, revision date 11/24).

2025version_updateLatest

Semi-annual review updated title to reflect V1.2025; removed panel testing note for Restrictive Cardiomyopathy Panels as investigational, reformatted FH criteria to separate children and adults and aligned FH references with 2018 ACC guidance, and added tissue-based GEP sections and citation updates for transplant gene expression testing.

Administrative note: the panel testing note for Restrictive Cardiomyopathy was removed because the RCM multigene panel criteria are investigational; this change is a formatting and content update recorded in the policy revision history.

Material changes in this revision include addition of tissue-based Gene Expression Profiling (GEP) criteria and updated ISHLT citations for post‑heart transplant testing, reformatting and revision of Familial Hypercholesterolemia (FH) criteria (including removal of medication-related genetic prerequisites), and multiple operational wording and panel‑specific criteria updates (for example, updates to sudden unexplained death language, age thresholds, and coverage formatting).