CurrentUnitedHealthcarePolicy CS048NE.F

Genetic Testing for Cardiac Disease (for Nebraska Only)

UnitedHealthcare Nebraska policy defining medical necessity criteria for multi-gene panel and related genetic testing for inherited arrhythmias, cardiomyopathies, thoracic aortic disease, and testing based on family history; includes recommended counseling, applicable CPT/PLA codes, definitions, and background evidence discussion. This is Part 1 of 4 and applies only to Nebraska members.

Policy Summary

PayerUnitedHealthcare

PolicyGenetic Testing for Cardiac Disease (for Nebraska Only)

Policy CodePolicy CS048NE.F

Change TypeCode addition (0617U)

Effective DateJun 1, 2026

Next Review Date

Key ActionDocument medical necessity in the patient medical record including history, exam, and relevant test results; provide pre- and post-test genetic counseling and follow variant-specific cascade testing guidance.

POLICY UPDATE CHANGES

Added CPT code 0617U to the applicable codes list.

9Major covered diagnostic categories listed

~17Molecular/CPT/PLA codes referenced

1State-specific policy (Nebraska)

30+Genes referenced

HTAD genes with strong/definitive evidence

1Code additions in this revision

Coverage Summary

This document is UnitedHealthcare's Nebraska-specific medical policy (Policy CS048NE.F) covering multi-gene panels and related genetic testing for inherited arrhythmias, cardiomyopathies, thoracic aortic disease, and genetic testing based on family history. This is Part 1 of 4 and applies only to Nebraska members. The policy addresses testing technologies including chromosome microarray analysis (CMA), next-generation sequencing (NGS) multi-gene panels, and assays that assess gene products such as gene expression arrays, among others, and references applicable PLA/CPT and molecular pathology codes. A material change in this revision (effective 06/01/2026) is the addition of CPT/PLA code 0617U to the list of applicable codes; the previous version CS048NE.E was archived.

High-level key values for providers

Major covered diagnostic categories listed9

Molecular/CPT/PLA codes referenced~17 (examples: 0237U, 0401U, 0439U, 0440U, 0466U, 0617U, 81410-81414, 81439, 81479, 81493)

State-specific policyApplies only to Nebraska members

Genes referenced30+ (e.g., RYR2, CASQ2, CALM1-3, SCN5A, KCNQ1, KCNH2, MYH7, MYBPC3, TTN, FBN1, TGFBR1/2, COL3A1, ACTA2, MYLK, PRKG1, LOX)

Code additions in this revision0617U added to applicable codes (Summary of Changes 06/01/2026)

Medical-Necessity Criteria

Pre-test counseling

Pre-test genetic counseling is strongly recommended to inform individuals about test advantages, limitations, and implications for themselves and family members.

ALL of the following

Pre-test genetic counseling provided by a qualified genetics professional (e.g., genetic counselor, medical geneticist, or other clinician with documented genetics expertise).
Documentation that the individual (or parent/guardian for minors) received counseling about potential benefits, limitations, possible outcomes (including variants of uncertain significance), and implications for family members.
Discussion of testing alternatives, potential need for cascade (family) testing if a pathogenic/likely pathogenic variant is identified, and insurance/financial considerations.

Brugada Syndrome (BrS)

Multi-gene panel testing for Brugada syndrome (BrS) is considered medically necessary when the individual meets diagnostic criteria or has a clinical phenotype strongly suggestive of BrS.

Not Medically Necessary / Unproven Tests

Not Medically Necessary / Unproven (explicit statements)

All other genetic testing for cardiomyopathies, arrhythmias, or aortic vascular disease is unproven and not medically necessary due to insufficient evidence of efficacy (except chromosome microarray analysis for isolated severe congenital heart disease).

Genetic testing for coronary artery disease (CAD) is unproven and not medically necessary (includes gene expression tests, microarray or other genetic profiles for cardiac disease risk such as Cardiac DNA Insight, Cardiac Healthy Weight DNA Insight, Cardio IQ gene tests and panels).

The policy concludes that evidence is insufficient to support routine clinical use of polygenic risk scores (PRS) or gene-expression tests for coronary artery disease (CAD). Performance of PRSs varies by ancestry with generally stronger associations in European and some Hispanic groups than in African ancestry groups, and genome-wide PRSs outperform restricted PRSs in many studies. Direct-to-consumer genetic tests for cardiovascular disease currently lack sufficient evidence and oversight and should be used with caution in clinical decision-making.

Applicable Codes

Covered / Applicable PLA/CPT and molecular pathology codes referencedmixed

0237U	Cardiac ion channelopathies genomic sequence analysis panel including ANK2, CASQ2, CAV3, KCNE1, KCNE2, KCNH2, KCNJ2, KCNQ1, RYR2, and SCN5A, including small sequence changes, deletions, duplications, mobile element insertions, and variants in non-uniquely mappable regions.
0401U	Cardiology (coronary heart disease), 9 genes (12 variants), targeted variant genotyping, algorithm reported as a genetic risk score for a coronary event.
0439U	Cardiology (CHD), DNA analysis of 5 SNPs and 3 DNA methylation markers, algorithm reported as a 3-year risk of symptomatic CHD.
0440U	Cardiology (CHD), DNA analysis of 10 SNPs and 6 DNA methylation markers, algorithm reported as detected or not detected for CHD.
0466U	Cardiology (CAD), DNA, genome-wide association studies (564,856 SNPs), patient lifestyle and clinical data, algorithm reported as polygenic risk to acquired heart disease.
0617U	Cardiovascular (ASCVD), DNA methylation analysis of more than 20,000 sites, algorithm reported as positive or negative risk.
81410	Aortic dysfunction or dilation genomic sequence analysis panel, must include sequencing of at least 9 genes including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK.
81411	Aortic dysfunction or dilation duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1.
81413	Cardiac ion channelopathies genomic sequence analysis panel, must include sequencing of at least 10 genes including ANK2, CASQ2, CAV3, KCNE1, KCNE2, KCNH2, KCNJ2, KCNQ1, RYR2, and SCN5A.
81414	Cardiac ion channelopathies duplication/deletion gene analysis panel, must include analysis of at least 2 genes including KCNH2 and KCNQ1.

1–10 of 13

1/2

No codes listed

Applicable CPT/HCPCS codes (updated)CPT|HCPCS

0617U

Newly added CPT/PLA-type code (specified in Summary of Changes).

No codes listed

Genes mentioned for testing (by condition)mixed

RYR2	CPVT definitive/strong evidence gene
CASQ2	CPVT definitive/strong evidence gene
CALM1	CPVT definitive/strong evidence gene
CALM2	CPVT definitive/strong evidence gene
CALM3	CPVT definitive/strong evidence gene
TRDN	CPVT definitive/strong evidence gene
TECRL	CPVT definitive/strong evidence gene
KCNJ2	CPVT phenocopy / SQTS optional testing
SCN5A	CPVT phenocopy / BrS index testing / Inherited AF gene
PKP2	CPVT phenocopy

1–10 of 37

1/4

No codes listed

Provider Actions & Requirements

Prior Authorization

Policy applies to Nebraska members

Policy applies to members of the State of Nebraska. Refer to designated expert centers for coordination of care and to ensure appropriate genetic counseling and testing workflows are followed prior to and after testing.

Applicable to Nebraska members only
Refer to expert centers and genetic counseling

Billing Rule

Applicable code updates

Use the codes below when submitting claims or requests. Verify coding with the most current coding manuals and payer billing guidance. This is a billing/coding reference and does not guarantee coverage.

0237U
0401U

Background & Evidence Summary

Technologies used in the evaluation of cardiac-related genetic conditions include tests that assess gene variation (for example, CMA and NGS multi-gene panels) and tests that assess gene expression or products (for example, gene expression arrays and microRNA analysis). These tests may range from single-gene assays to whole-exome or whole-genome sequencing and can inform diagnosis, prognosis, and clinical management. This policy addresses genetic test panels or microarray profiles that evaluate five or more genes for cardiac-related syndromes and coronary artery disease risk. Cardiomyopathies that present primarily with neuromuscular features and related genetic testing are excluded from this policy and are covered under the separate Nebraska policy "Genetic Testing for Neurological Disorders (for Nebraska Only)."

Metric	Value
Detection rates - arrhythmia panels	Arrhythmia panels: 34.8% VUS, 4.2% likely pathogenic, 4.6% pathogenic (Van Lint et al.)
Genetic testing PPV for LQTS	70–80% positive predictive value compared with ECG criteria and family history; ~72–80% of clinically diagnosed LQTS have an identifiable variant
HCM penetrance in relatives (Neilsen 2023)	39% penetrance among P/LP variant-carrying relatives (160/407)
HCM penetrance - Topriceanu 2024 meta-analysis	57% penetrance in non-proband relatives (95% CI 52%–63%); pooled phenotypic conversion 15% over ~8 years
Hathaway et al. 2021 diagnostic yield (HCM)	Diagnostic variants in 26.8% (369/1,376) of tested samples
Genetic DCM prevalence (Myers 2024)	Median genetic DCM prevalence 20.2%; TTN-associated 11.4%; MYH7-associated 3.2%
UK Biobank PRS C-index improvement	Addition of PRS increased C-index by 0.012 (95% CI 0.009–0.015)
PRE-DETERMINE GPSCAD top decile absolute risk	Top decile GPSCAD: 8.0% vs 4.8% absolute sudden death risk (p < 0.005)
ARIC/MESA PRS hazard ratios per SD	ARIC HR 1.24 (95% CI 1.15–1.34); MESA HR 1.38 (reported 95% CI overlapping figures)
eMERGE PRSmetaGRS hazard ratios per 1 SD	EA 1.53 (1.46–1.60); HE 1.53 (1.23–1.90); AA 1.27 (1.13–1.43)
Relative risk high vs low genomic risk (meta-analysis)	~91% higher CHD risk in high genetic risk vs low (Khera et al. 2016)
Lifestyle impact across genomic risk groups	Favorable lifestyle associated with ~45% reduced CHD risk across genomic risk groups (Khera et al. 2016)
Net reclassification improvement (example)	~9% net reclassification improvement for certain SNP profiles versus Framingham in intermediate-risk groups

Definitions

Term	Definition
First-Degree Relative	Parents, siblings, and offspring. [NCCN, 2025]
Second-Degree Relative	Half-brothers/sisters, aunts/uncles, grandparents, grandchildren, and nieces/nephews affected on the same side of the family. (NCCN, 2025)
Multi-Gene Panel	Genetic tests using next-generation sequencing to test multiple genes simultaneously. Also called Multiple Gene Panel.
Schwartz Score	Diagnostic criteria for long QT syndrome with scoring across ECG, clinical history, and family history; scoring thresholds define low/intermediate/high probability.
P/LP	Pathogenic or likely pathogenic variant
VUS	Variant of uncertain significance
Index case / proband	The first affected family member who seeks medical attention for a genetic disorder
PRS	Polygenic risk score, aggregate genetic risk from multiple variants
HTAD	Heritable thoracic aortic disease
Polygenic Risk Score (PRS) - detailed	A genomic risk score derived from combining multiple single nucleotide polymorphisms (SNPs) weighted by effect sizes to estimate genetic predisposition to disease.

Key Clinical Thresholds & Diagnostic Scores

Key thresholds and diagnostic cutoffs

QTc thresholds for LQTS diagnostic ECG> 470 ms (males) or > 480 ms (females) diagnostic; policy uses > 460 ms for certain exercise/ambulatory/provocation findings

Schwartz Score categories≤ 1.0 = low; 1.5–3.0 = intermediate; ≥ 3.5 = high (policy references ≥1.5 for panel consideration and ≥3.5 per guidelines)

CPVT diagnostic score cutoffs> 3.5 = definite; ≥ 2 and < 3.5 = modest phenotype (testing recommendations vary by score)

SQTS diagnostic score> 4 (Class 1 diagnostic) ; testing consideration if score ≥ 4

HCM wall thickness for diagnosis≥ 13–15 mm in adults for clinical diagnosis

Allele frequency cutoff for targeted SCN5A VUSPopulation allele frequency < 1 x 10^-5 for targeted family sequencing consideration

Revision History

2026-06-01material_changeLatest

Summary of Changes dated 06/01/2026: updated applicable CPT codes list with quarterly edits including addition of CPT/PLA code 0617U; policy number CS048NE.F effective June 1, 2026.

archivalarchival_note

Previous policy version CS048NE.E archived (per Summary of Changes).

Policy Summary

PayerUnitedHealthcare

PolicyGenetic Testing for Cardiac Disease (for Nebraska Only)

Policy CodePolicy CS048NE.F

Change TypeCode addition (0617U)

Effective DateJun 1, 2026

Next Review Date

On This Page

ANY of the following

Individual meets diagnostic criteria for Brugada syndrome, including spontaneous Type 1 Brugada ECG pattern.
Drug-provoked Type 1 Brugada ECG pattern (sodium channel blocker challenge) with clinical features or symptoms consistent with BrS.
Individual with documented ventricular arrhythmia or unexplained syncope with ECG features suggestive of BrS.
Asymptomatic First- or Second-Degree Relative of an individual with a known pathogenic or likely pathogenic variant in a BrS-associated gene.

Short QT Syndrome (SQTS)

Short QT syndrome (SQTS) multi-gene testing is medically necessary when clinical evidence indicates SQTS or there is a pathogenic family variant.

ANY of the following

Documented persistently short QTc interval consistent with diagnostic thresholds for SQTS after exclusion of secondary causes (e.g., electrolyte abnormalities, medications).
Personal history of atrial fibrillation at a young age or ventricular arrhythmia with a short QTc and suspicion for SQTS.
Asymptomatic First- or Second-Degree Relative of an individual with a known pathogenic or likely pathogenic variant in an SQTS-associated gene.

Inherited Atrial Fibrillation (Inherited AF)

Genetic testing for inherited atrial fibrillation (Inherited AF) may be considered medically necessary in select situations where a heritable monogenic cause is suspected.

ANY of the following

Early-onset atrial fibrillation (onset <45 years) without identifiable acquired causes (e.g., structural heart disease, hyperthyroidism) and with family history suggestive of Mendelian inheritance.
Atrial fibrillation in the setting of syndromic features or cardiomyopathy where a pathogenic variant explaining AF is suspected.
Asymptomatic First- or Second-Degree Relative of an individual with a known pathogenic or likely pathogenic variant for an inherited arrhythmia/cardiomyopathy gene in which AF is a recognized manifestation.

Arrhythmogenic Cardiomyopathy (ACM) / ARVC

Multi-gene panel testing for arrhythmogenic cardiomyopathy (ACM) / arrhythmogenic right ventricular cardiomyopathy (ARVC) is medically necessary when diagnostic criteria or a suggestive phenotype is present.

ANY of the following

Individual meets diagnostic criteria for ACM/ARVC based on Task Force criteria (combination of imaging, electrocardiographic, histopathologic, and family history findings).
Unexplained ventricular arrhythmias, syncope, or sudden cardiac arrest with imaging or ECG findings suspicious for ACM/ARVC.
First- or Second-Degree Relative of an individual with a known pathogenic or likely pathogenic variant in an ACM/ARVC-associated gene.

Left Ventricular Noncompaction (LVNC) / Noncompaction Cardiomyopathy (NCCM)

Genetic testing for left ventricular noncompaction cardiomyopathy (LVNC / NCCM) is medically necessary when imaging and clinical findings support the diagnosis or when familial testing is indicated.

ANY of the following

Individual with imaging (echocardiography or cardiac MRI) diagnostic of LVNC/NCCM with clinical features (e.g., heart failure, arrhythmia, thromboembolism) and no alternative explanation.
Unexplained cardiomyopathy with left ventricular noncompaction features and a suspicion of a heritable cardiomyopathy.
Asymptomatic First- or Second-Degree Relative of an individual with a known pathogenic or likely pathogenic variant in an LVNC-associated gene.

General recommendations from professional societies

Professional society recommendations summarize guidelines that inform testing indications and family screening.

ALL of the following

ACC/AHA, HRS, EHRA, APHRS, and LAHRS recommend genetic testing for inherited cardiomyopathies and channelopathies when clinical diagnostic criteria are met and to facilitate cascade testing in relatives when a pathogenic variant is identified.
Society guidance supports genetic testing for HCM when unexplained left ventricular hypertrophy is present (after excluding secondary causes) to inform management and family screening.
For HTAD, ACC/AHA and other vascular society guidance support genetic testing in individuals with confirmed thoracic aortic disease or a family history suggestive of hereditary thoracic aortic disease to guide management and surveillance.
Societies note that genetic testing should be performed with appropriate pre- and post-test counseling and that variant interpretation should follow ClinGen/ACMG standards.

Hypertrophic Cardiomyopathy (HCM) - EHRA/HRS/APHRS/LAHRS recommendations

Hypertrophic cardiomyopathy (HCM) testing recommendations from EHRA/HRS/APHRS/LAHRS.

ALL of the following

Genetic testing is recommended for individuals with unexplained left ventricular hypertrophy consistent with HCM (after excluding secondary causes such as hypertension, valve disease, infiltrative disease).
Testing should include sarcomere genes and other relevant genes per current expert consensus panels; positive results should prompt cascade testing in relatives.
Testing is not routinely recommended for individuals with mild LVH and an identifiable alternative cause; clinical context and family history should guide testing decisions.

Arrhythmogenic Cardiomyopathy (ACM) recommendations

Arrhythmogenic Cardiomyopathy (ACM) recommendations emphasizing diagnosis, testing, and family screening.

ALL of the following

Genetic testing is recommended in individuals who meet diagnostic criteria for ACM to identify a causative variant and enable cascade testing of at-risk relatives.
Evaluation should integrate genetic results with clinical, imaging, and ECG data; a negative genetic test does not exclude disease and clinical follow-up should continue based on phenotype.

Left Ventricular Noncompaction (LVNC) guidance

Left ventricular noncompaction (LVNC) guidance from expert consensus.

ALL of the following

Genetic testing is recommended for individuals with confirmed LVNC when a heritable cause is suspected (familial disease, early-onset disease, or accompanying cardiomyopathy features).
Cascade testing of relatives is advised when a pathogenic or likely pathogenic variant is identified; management decisions should combine genetic and clinical data.

Inherited Thoracic Aortic Disease (HTAD) - ACC/AHA and other societies

Inherited Thoracic Aortic Disease (HTAD) testing recommendations from ACC/AHA and other societies.

ANY of the following

Genetic testing is indicated for individuals with confirmed thoracic aortic aneurysm/dissection, particularly when early onset, syndromic features, or family history is present.
Genetic testing is indicated for individuals with a family history (First- or Second-Degree Relative) of HTAD or sudden unexplained aortic catastrophe, to guide surveillance and surgical threshold decisions.

Gene curation and evidence levels (ClinGen/ClinVar summaries)

Gene curation, evidence levels, and variant interpretation guidance.

ALL of the following

Gene-disease relationships should be interpreted using curated resources (e.g., ClinGen gene curation) to assess strength of evidence for inclusion on diagnostic panels.
Variant classification should follow ACMG/AMP standards and ClinGen specifications; laboratories should submit clinically significant variants to public databases (e.g., ClinVar).
Genes with limited or disputed evidence should be excluded from clinical diagnostic panels or listed separately with clear statements about limited evidence to avoid over-interpretation.

Polygenic risk scores (PRS) and coronary artery disease (CAD)

Summary on polygenic risk scores (PRS) and coronary artery disease (CAD).

ALL of the following

Current evidence does not support routine clinical use of polygenic risk scores (PRS) for coronary artery disease as a standalone indication for genetic testing for clinical management in this policy context.
Proprietary genomic risk algorithms and multi-marker risk scores for CAD are considered unproven and not medically necessary due to insufficient evidence of clinical utility, consistent with applicable society statements.
If PRS results are provided, they should be reported with limitations, and clinical decisions should be based on established risk factors and guideline-recommended management rather than PRS alone.

Documentation Required

Medical record documentation required

The patient's medical record must contain documentation that fully supports the medical necessity for the requested genetic testing. Documentation should be legible, maintained in the patient's record, and made available upon request.

Relevant medical history
Physical examination findings
Pertinent diagnostic test results (e.g., ECG, echocardiogram, Holter)
Clinical rationale linking phenotype to testing requested

Prior Authorization

Variant-specific testing for relatives

When a pathogenic or likely pathogenic (P/LP) variant is identified in an affected proband, offer variant-specific testing to at-risk relatives to establish carrier or affected status. Testing should target the known familial variant.

Offer targeted variant testing for identified P/LP variants in relatives
Provide the specific variant notation (HGVS) and lab report when referring relatives
Document relationship and degree of relatedness

Documentation Required

Genetic counseling recommended

Genetic counseling is strongly recommended before testing to explain benefits, limitations, potential outcomes, and implications for family members. Counseling should be documented in the medical record.

Pre-test genetic counseling recommended
Post-test genetic counseling for result interpretation and family cascade planning

Documentation Required

Cascade screening workflow

Cascade screening should follow identification of a P/LP variant in a proband. Prioritize first-degree relatives, then second-degree relatives as indicated. Provide clear communication of results and testing recommendations to family members.

Initiate cascade testing for identified P/LP variants
Prioritize first-degree relatives
Document outreach efforts and counseling provided

Documentation Required

Postmortem testing

Postmortem (molecular autopsy) testing may be appropriate when sudden unexplained death is suspected to be due to inherited cardiac disease. Document indication, consent, and coordinate with pathology and genetic counseling services.

Include indication for molecular autopsy in request
Coordinate specimen handling and chain of custody
Document consent and family notification

Billing Rule

Targeted VUS sequencing for family members

Targeted sequencing of a variant of uncertain significance (VUS) in relatives is generally not appropriate for diagnostic clarification and is only reasonable in limited circumstances where it may inform segregation and reclassification efforts. Document the rationale.

Targeted VUS sequencing for family members only with documented rationale
Include pedigree and segregation hypothesis

Denial Risk

Cascade testing not useful when proband negative

Cascade testing is unlikely to be useful when the proband is negative for a pathogenic or likely pathogenic variant. Avoid routine testing of relatives in the absence of an identifiable familial P/LP variant.

Do not perform cascade testing when proband testing is negative for P/LP variants
Consider clinical surveillance based on phenotype and family history instead

Denial Risk

Avoid testing in isolated/incidental LVNC without features

Avoid genetic testing for isolated or incidental left ventricular noncompaction (LVNC) in the absence of other phenotypic features suggestive of an inherited cardiomyopathy. Testing should be driven by a compatible phenotype or family history.

Do not test for cardiomyopathy genes for isolated/incidental LVNC without additional clinical features
Require documentation of symptomatic or familial indicators

Documentation Required

Serial re-evaluation of variants

Genetic variants should be periodically re-evaluated as new evidence emerges. Laboratories and providers should document reclassification efforts and notify patients when variant interpretation changes that impact management.

Serial re-evaluation of variants recommended
Document laboratory reclassification policies and patient notification procedures

Documentation Required

Three-generation family history and pedigree

Obtain a detailed three-generation family history and construct a pedigree to inform testing strategy. Include ages at diagnosis, ages at death, sudden unexplained deaths, and ethnicity when relevant.

Three-generation family history and pedigree required
Document ages, diagnoses, and sudden/unexplained deaths

Documentation Required

Phenotypic evaluation before testing

Perform a thorough phenotypic evaluation before ordering genetic testing. This may include ECG, echocardiography, Holter monitoring, exercise testing, and other relevant cardiac investigations to match genotype-phenotype correlations.

Phenotypic evaluation (ECG, echo, Holter, exercise testing) prior to testing
Document diagnostic scores (e.g., Schwartz Score) and clinical findings

Documentation Required

Use of third-party tools

The use of third-party variant interpretation tools or external databases can supplement laboratory reports but should not replace clinical correlation and expert interpretation. Document tools used and how they informed clinical decision-making.

Use of third-party tools documented and correlated with clinical context
Do not rely solely on automated tools for clinical decision-making

Documentation Required

Policy usage instructions

Follow the policy’s instructions when preparing prior authorization requests and documentation packages. Include clinical history, test rationale, family history, relevant diagnostic test results, and evidence of genetic counseling when applicable.

Include clinical history and test rationale with requests
Attach pedigree, prior genetic test results, and counseling documentation

LVEF threshold relevant to DCM testing utilityLVEF < 35% considered for genetic testing in apparently sporadic DCM with severe systolic dysfunction

Predictive testing age thresholds for children> 10–12 years recommended for predictive testing in many cardiomyopathies/ACM/DCM; some conditions (BrS, CPVT) allow testing from birth for known P/LP variants

Providers should document the patient's phenotype and diagnostic score or relevant ECG findings (for example, CPVT diagnostic score, SQTS diagnostic score, or type I Brugada ECG) and other supporting clinical features in the medical record prior to ordering gene panel testing. Establishing and recording the diagnostic score/ECG/phenotype is required to support medical necessity for panel or gene-specific testing.