New or Updated Policies - Effective May 1, 2026

Policy Number

Policy Name

Description

Line(s) of Business

V2.2025                

Concert Genetic Testing: Multisystem Genetic Conditions

Annual review. Policy name changed from “Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay” to “Concert Genetic Testing: Multisystem Genetic Conditions.” Criteria added for Mitochondrial Genome Sequencing, Deletion/Duplication, and/or Nuclear Gene Panels from the previously named “Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders.” The following criteria were added to this policy from the policy previously named “Concert Genetic Testing: Aortopathies and Connective Tissue Disorders”: Classic Ehlers-Danlos Syndrome (cEDS) Multigene Panel; COL3A1 Sequencing and/or Deletion/Duplication Analysis; Comprehensive Connective Tissue Disorders Multigene Panel; Loeys-Dietz Syndrome Multigene Panel; FBN1 Sequencing and/or Deletion/Duplication Analysis; Other Covered Connective Tissue Disorders. The following criteria were added to this policy from the policy previously named “Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders”: Rapid Exome Sequencing; Rapid Genome Sequencing; Reanalysis of Exome or Genome Sequencing Data Standard Exome Sequencing; Standard Genome Sequencing.” Minor rewording without clinical significance throughout. Changed all “investigational” policy statements to note that “current evidence does not support…” Definitions for Type A and B aortic dissections were moved under a shared definition. Changed the definition of global developmental delay to specify that individuals meeting this criteria must be under age 5, applicable to the following criteria sections: Rapid Exome Sequencing; Rapid Genome Sequencing; Reanalysis of Exome or Genome Sequencing Data Standard Exome Sequencing; Standard Genome Sequencing. Policy reference table, related policy list, rationale section and references updated.

Medicaid; Medicare

CP.MP.102                               

Pancreas Transplant

Annual review. Under criteria I.A.1. specified “type I” and removed “(members/enrollees with requirements…). Under I.B.1.a. replaced “require” with “required” and “room” with “department”. Reworded criteria under I.B.1.b. with no impact on criteria. Under I.B.2.c. removed “(does not have to be…) and added “or dialysis dependent”. Under. I.B.3.c.ii. added “specified as greater than 500mg/day”. Moved contraindications under I.B. to I.C. References reviewed and updated. Reviewed by internal and external specialist.

Medicaid; Medicare

CP.MP.136               

Home Births         

Annual review. Removed previous criteria I.C. through I.I. and created new criteria I.C.1. through I.C.8. Background updated with no impact to criteria. References reviewed and updated. Reviewed by internal specialist.

Medicaid; Medicare

CP.MP.162                               

Tandem Transplant

Annual review. Updated Criteria I.A.2. to include ovarian germ cell tumors. Updated Criteria I.A.3. from neuroblastoma characteristics from the International Neuroblastoma Staging System (INSS) to characteristics from the International Neuroblastoma Risk Group Staging System (INRGSS) and Children's Oncology Group (COG) neuroblastoma high-risk disease group. Background updated with to reflect information regarding INRGSS. Coding and descriptions reviewed. References reviewed and updated. Reviewed by internal specialist and external specialist.

Medicaid; Medicare