Implementing GeNomics In pracTicE TOOLBOX y PUBLICATIONS ...
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� IGNT� Implementing GeNomics In pracTicE TOOLBOX y PUBLICATIONS NEWS EVENTS NETWORK y ABOUT IGNITE I Map of Pharmacogenetic Test Reimbursement According to MAC Click on a state to see what Medicare Administrative contractor (MAC) seNes the state, which genetic tests are covered by the MAC, as well as the associated indication and non-covered i ndication for each non-medical ly necessary pharmacogenetic test. Click here to see a list of PGX tests determined to be medically necessary for Medicare coverage. Note: The location of the laboratory running the test determines which MAC the test is covered under, which may be different than the MAC covering the state where patient lives or the MAC in which the test is ordered. m• First Coast Revi si on Effective Dat e: 10/1/2017 Genec Test Covered Indic@ion Non-covered Indic@ions CYP2C19 y CYP2D6 y CYP2C9 y ACS patients undergoing PCI initiating or reinitiating clopidogrel therapy. ICD-10 Codes that Support Medical Necessity Initi al therapy pl anned with: amitriptyl ine/nortriptyli ne (for depressi on) and t etrabenazi ne doses >50 mg/day or r ei nitiati on of tetrabenazi ne doses >50 mg/day. ICD-10 Codes that Support Medical Necessity Warfari n anti coagul ati on therapy candidates with: no previous testing for CYP2C9 or VKORCl alleles, < 5 days of warfarin i n anticoagulation regimen for which testing is ordered and enr ollment in a prospective, randomized, controlled cli nical study Considered investigational for (not limited to) : amitriptyline, cl opidogrel (for other indications than mentioned before), PPls, SSRls, and warfarin Considered investigati onal for (not limited to): antidepressants other than those list ed pr eviousl y , antipsychotics, codeine, donepezil, gal antamine, tamoxifen All other coverage f or genetic testing outsi de Coverage with Evi dence Development (CED) standards is considered investi gational at t his time . There i s currentl y no proven clinical uti lity related to any medication, i ncl uding but not limited to: • ,. #
Transcript of Implementing GeNomics In pracTicE TOOLBOX y PUBLICATIONS ...
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IGNT� Implementing GeNomics In pracTicE
TOOLBOX y PUBLICATIONS NEWS EVENTS NETWORK y ABOUT IGNITE
I Map of Pharmacogenetic Test Reimbursement According to MAC
Click on a state to see what Medicare Administrative contractor (MAC) seNes the state, which genetic tests are covered by the MAC, as
well as the associated indication and non-covered indication for each non-medically necessary pharmacogenetic test.
Click here to see a list of PGX tests determined to be medically necessary for Medicare coverage.
Note: The location of the laboratory running the test determines which MAC the test is covered under, which may be different than the MAC
covering the state where patient lives or the MAC in which the test is ordered.
m•
First Coast Revision Effective Date: 10/1/2017
Genetic Test Covered Indication Non-covered Indications
CYP2C19 y
CYP2D6 y
CYP2C9 y
ACS patients undergoing PCI initiating or reinitiating clopidogrel therapy.
ICD-10 Codes that Support Medical Necessity
Initial therapy planned with: amitriptyl ine/nortriptyline (for depression) and tetrabenazine doses >50 mg/day or reinitiation of tetrabenazine doses >50 mg/day. ICD-10 Codes that Support Medical Necessity
Warfarin anticoagulation therapy candidates with: no previous testing for CYP2C9 or VKORCl alleles, < 5 days of warfarin in anticoagulation regimen for which testing is ordered and enrollment in a prospective, randomized, controlled clinical study
Considered investigational for (not limited to) : amitriptyline, clopidogrel (for other indications than
mentioned before), PPls, SSRls, and warfarin
Considered investigational for (not limited to): antidepressants other than those listed previously, antipsychotics, codeine, donepezil, galantamine, tamoxifen
All other coverage for genetic testing outside Coverage with Evidence Development (CED) standards is considered investigational at this time. There is currently no proven clinical utility related to any medication, including but not limited to:
• ,. #
