Blue Shield of CaliforniaAll Plans · Coverage · Genetic Testing · CA · Genetics, Audiology, ENT (Ear, Nose & Throat)Medium impact
Genetic Testing for Hereditary Hearing Loss (2.04.87)
Effective date
Aug 1, 2026
Identified
Nov 1, 2025
Summary
Genetic testing for hereditary hearing loss genes, including GJB2 and GJB6, may be considered medically necessary to confirm hereditary hearing loss in individuals with suspected hearing loss. Preconception carrier testing in parents may be considered medically necessary when at least one of four conditions is met: offspring with hereditary hearing loss, one or both parents with suspected hereditary hearing loss, a first- or second-degree relative affected with hereditary hearing loss, or a first-degree relative with an affected offspring. Testing in all other situations, including testing individuals without hearing loss, is considered investigational.
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01Already effective August 1, 2026: Please provide the following documentation for clinical review: clinical findings (pertinent symptoms and duration), activity and functional limitations, family history if applicable, reason for the test, pertinent past procedural and surgical history, past and present diagnostic testing and results including hearing test results, and prior conservative treatments with duration and response.
02Also provide consultation and medical clearance reports when applicable, radiology reports and interpretations (MRI, CT) if applicable, and laboratory results if applicable.
03Coverage follows the member's contract benefits in effect at the time of service.
Codes mentioned
8125281253812548143081431
Original notice
Genetic Testing for Hereditary Hearing Loss (2.04.87)
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