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Genetic Testing for Hereditary Hemochromatosis

Blue Cross & Blue Shield of Mississippi·MS · Family Medicine, Internal Medicine, Gastroenterology +1 more·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

New medical policy establishes coverage criteria for genetic testing for hereditary hemochromatosis. Testing is considered medically necessary for individuals with abnormal serum iron indices indicating iron overload or those with a family history of hemochromatosis in a first-degree relative. General population screening remains investigational and not covered.

Action Required

Action needed
Immediately: Billing team must ensure genetic testing for hereditary hemochromatosis is only billed when documentation shows either abnormal serum iron indices (elevated transferrin saturation >45% or elevated serum ferritin) or confirmed family history of hemochromatosis in first-degree relative. Update prior authorization workflows to verify these criteria are met before testing. Claims for general population screening will be denied as investigational.