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Blue Shield of CaliforniaAll Plans · Coverage · Genetic Testing · CA · Genetics, Neurology, Cardiology +1 moreMedium impact

Genetic Testing for Duchenne and Becker Muscular Dystrophy (2.04.86)

Effective date
Aug 1, 2026
Identified
Nov 1, 2025

Summary

Genetic testing for DMD gene variants may be considered medically necessary in males with signs and symptoms of a dystrophinopathy to confirm the diagnosis and direct treatment, in at-risk female relatives to confirm or exclude the need for cardiac surveillance or for preconception testing, and in at-risk male offspring to confirm or exclude the need for medical and cardiac surveillance. At-risk females are first- and second-degree female relatives, including the proband's mother, female siblings, female offspring, and the proband's maternal grandmother and maternal aunts, and at-risk males are asymptomatic male offspring of a female carrier or asymptomatic male siblings of an individual with a DMD-associated dystrophinopathy. Genetic testing for DMD gene variants is considered investigational in all other situations.

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What to do

Action · 4 steps
01Already effective August 1, 2026: Please provide the following documentation for clinical review: diagnosis and presenting symptoms, past treatment plan and responses, familial history as it relates to high-risk female patients, pre-pregnancy considerations, and treatment strategy per request.
02After service, also include the results or reports of tests performed and the procedure reports.
03For at-risk female relatives, when the proband's DMD variant is known, test for that deletion or duplication or SNV using an appropriate testing method.
04When an affected male is not available for testing, test by deletion and duplication analysis first and, if no CNV is identified, by sequence analysis.

Codes mentioned

8116181408

Original notice

Genetic Testing for Duchenne and Becker Muscular Dystrophy (2.04.86)
blueshieldca.com · Always check the source before changing claims.
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