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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · Genetics, CardiologyMedium impact

Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Under this BCBS policy, genetic testing for predisposition to hypertrophic cardiomyopathy may be considered medically necessary for individuals who have a first-degree relative with established hypertrophic cardiomyopathy, when a known pathogenic gene variant is present in that affected relative. Testing is considered investigational for individuals whose first-degree relative with established hypertrophic cardiomyopathy tested negative for pathogenic variants, and for all other populations. The policy history records an 08/18/2026 review with the policy statements unchanged and the code reference updated to remove ICD-9 diagnosis codes.

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What to do

Action · 5 steps
01Billing team: Genetic testing for predisposition to hypertrophic cardiomyopathy may be considered medically necessary only for individuals at risk, meaning those with a first-degree relative with established hypertrophic cardiomyopathy when a known pathogenic gene variant is present in that relative.
02Testing for all other populations is considered investigational under this policy.
03The policy lists CPT 81439, HCPCS S3865 and S3866, and ICD-10 I42.1, I42.2 and Z82.49 in its code reference, and states that these codes are medically necessary only if the procedure is performed according to the policy statement.
04Genetic testing should initially be performed in at least one close relative with definite hypertrophic cardiomyopathy (index case), if possible.
05Check the member's specific benefit plan language, since the Medical Policy Manual guidelines should not be used in place of it.

Codes mentioned

81439S3865S3866I42.1I42.2Z82.49

Original notice

Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
bcbsms.com · Always check the source before changing claims.
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