Summary
Already effective 2025-10-01: the code reference added ICD-10 diagnosis code QA0.0101 for SCN2A-related neurodevelopmental disorder. Genetic testing for genes associated with infantile- and early-childhood-onset epilepsy syndromes, in which epilepsy is the core clinical symptom, may be considered medically necessary when positive test results may lead to changes in medication management, changes in diagnostic testing so that alternative potentially invasive tests are avoided, or changes in reproductive decision making. Genetic testing for epilepsy is considered investigational for all other situations.
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What to do
Action · 4 steps
01Billing team: Before billing genetic testing for epilepsy, confirm the patient has an infantile- or early-childhood-onset epilepsy syndrome in which epilepsy is the core clinical symptom, because the policy considers testing investigational in all other situations.
02Confirm that positive results may lead to changes in medication management, in diagnostic testing so that alternative potentially invasive tests are avoided, or in reproductive decision making.
03Where an SCN1A-associated syndrome is suspected, the policy says testing should begin with sequence analysis of the SCN1A coding region, followed by deletion and duplication analysis if no pathogenic variant is identified.
04The code reference states that the listed codes are only medically necessary if the procedure is performed according to the policy section.
Codes mentioned
8140181403814048140581406814078141981479G40.001G40.919G40.A01G40.B19
Original notice
Genetic Testing for Epilepsy
bcbsms.com · Always check the source before changing claims.
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