Does Not Apply to Commercial Genetic Testing Program effective 6/1/2018
Individual genes and genetic variances have been associated with certain mental health disorders. Individual and panel genetic tests have been proposed as a diagnostic tool and a predictor of risk for several mental health conditions, including schizophrenia, psychotic disorders, depression, bipolar, obsessive-compulsive disorder and substance-related and addictive disorders. Genetic variants that have been implicated in mental health disorders include, but are not limited to:
ANK3 - associated with bipolar disorder
SLC6A4 - associated with anxiety, obsessive compulsive disorder
OPRMI & DRD2 - associated with addictive behaviors (e.g., smoking, alcoholism)
CACNA1C - associated with mood disorders
Commercially available testing panels include several of these genes (e.g., Mental Health DNA Insight™ panel) and are intended to aid in the risk assessment or diagnosis of mental health disorders.
Genetic testing (individual or panel) for variants associated with mental health disorders, including but not limited to, the following, is considered investigational:
To confirm a diagnosis of a mental health disorder in an affected individual
To predict future risk of a mental health disorder in an asymptomatic individual
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
Although studies have suggested that there may be a number of genetic variants associated with increased risk of mental health disorders, estimates of the increased risk vary across studies. There is a lack of evidence available to evaluate how testing for genetic variants improves net health outcomes.
BlueCross BlueShield Association. Evidence Positioning System. (8:2020). Genetic testing for diagnosis and management of mental health conditions (2.04.110). Retrieved February 10, 2021 from https://www.evidencepositioningsystem.com/. (34 articles and/or guidelines reviewed)
Gatt, J., Burton, K., Williams, L., & Schofield, P. (2015). Specific and common genes implicated across major mental disorders: a review of meta-analysis studies. Journal of Psychiatric Research, 60, 1-13. Abstract retrieved July 18, 2016 from PubMed database.
Jiang, H., Qiao, F., Li, Z., Zhang, Y., Cheng, Y., Xu, X., & Yu, L. (2015). Evaluating the association between CACNA1C rs1006737 and schizophrenia risk: a meta-analysis. Asia Pacific Psychiatry, 7 (3), 260-267. Abstract retrieved July 18, 2016 from PubMed database.
Liu, L., Fan, D., Ding, H., Hu, Y., Cai, G., Wang, L., et al. (2014). The relationship between DRD2 gene polymorphisms (C957T and C939T) and schizophrenia: a meta-analysis. Neuroscience Letters, 583, 43-48. Abstract retrieved July 18, 2016 from PubMed database.
McGrath, L., Cornelis, M., Lee, P., Robinson, E., Duncan, L., Barnett, J., et al. (2013). Genetic predictors of risk and resilience in psychiatric disorders: A cross-disorder genome-wide association study of functional impairment in major depressive disorder, bipolar disorder, and schizophrenia. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 0 (8), 779–788. (Level 1 evidence)
Pasman, J.S., Verwejj, K.J.H., & Vink, J.M. (2019). Systematic Review of polygenic gene–environment interaction in tobacco, alcohol, and cannabis use. Behavior Genetics, 49 (4), 349-365. (Level 2 evidence)
ORIGINAL EFFECTIVE DATE: 5/10/2014
MOST RECENT REVIEW DATE: 4/8/2021
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.