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Genetic Testing for Duchenne and Becker Muscular Dystrophy (2.04.86)
Blue Shield of California·CA · Genetics, Neurology, Cardiology +1 more·Genetic Testing
Effective date
Jun 1, 2026
We identified it
Nov 1, 2025
Summary
Blue Shield of California updated their policy for genetic testing of Duchenne and Becker muscular dystrophy, establishing specific criteria for when DMD gene variant testing is considered medically necessary versus investigational. The policy covers testing for symptomatic males, at-risk female relatives for cardiac surveillance and preconception planning, and at-risk male offspring for medical surveillance.
Action Required
Before June 1, 2026: Review current DMD genetic testing claims to ensure they meet the new medical necessity criteria. Update prior authorization requests to include specific documentation showing the patient meets one of the covered conditions (symptomatic male with dystrophinopathy signs, at-risk female relatives for cardiac surveillance or preconception testing, or at-risk male offspring for surveillance). Claims not meeting these criteria will be considered investigational and denied.