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Genetic Testing for Duchenne and Becker Muscular Dystrophy
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi policy A.2.04.86 treats DMD gene variant testing as medically necessary in a male with signs and symptoms of a dystrophinopathy to confirm the diagnosis and direct treatment. It also covers testing for at-risk female relatives to confirm or exclude the need for cardiac surveillance, preconception testing for a woman considering a pregnancy, and testing for at-risk male offspring to confirm or exclude the need for medical and cardiac surveillance. Genetic testing for DMD gene variants is considered investigational in all other situations.
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What to do
Action · 4 steps
01Billing team: Bill DMD gene testing codes (CPT 0218U, 81161, 81408) only when the test is performed for one of the policy's medically necessary indications: a male with signs and symptoms of a dystrophinopathy, an at-risk female relative needing cardiac surveillance decision, preconception testing, or an at-risk male offspring needing medical and cardiac surveillance decision.
02Billing team: Document that the testing is medically necessary, because BCBSMS makes no payment for services that are not documented to be medically necessary and a physician's order or recommendation alone does not make a service medically necessary.
03Billing team: Note that the policy treats testing in all other situations as investigational.
04Providers: Genetic counseling is recommended by experts for at-risk individuals who wish to undergo genetic testing, and it should be performed by an individual with experience and expertise in genetic medicine and genetic testing.
Codes mentioned
8116181408G71.00G71.01G71.09G71.11Z31.430Z31.440Z13.71
Original notice
Genetic Testing for Duchenne and Becker Muscular Dystrophy
bcbsms.com · Always check the source before changing claims.
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