Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Genetics, Neurology, OncologyMedium impact
Genetic Testing for Neurofibromatosis
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Genetic testing for NF1 or NF2 pathogenic variants may be considered medically necessary when a diagnosis of neurofibromatosis is clinically suspected due to signs of disease but a definitive diagnosis cannot be made without genetic testing. Genetic testing for NF1 or NF2 pathogenic variants in at-risk relatives with no signs of disease may be considered medically necessary when a definitive diagnosis cannot be made without genetic testing and a close relative (first-, second- or third-degree) has a known NF1 or NF2 variant or has been diagnosed with neurofibromatosis but whose genetic status is unavailable. Genetic testing for neurofibromatosis in all other situations is considered investigational.
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01Billing team: Bill genetic testing for NF1 or NF2 pathogenic variants as medically necessary only when neurofibromatosis is clinically suspected due to signs of disease and a definitive diagnosis cannot be made without genetic testing.
02Billing team: For at-risk relatives with no signs of disease, bill as medically necessary only when a definitive diagnosis cannot be made without genetic testing and at least one of the close-relative criteria in the policy is met.
03Billing team: Treat all other genetic testing for neurofibromatosis as investigational and do not bill it as medically necessary.
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