Does Not Apply to Commercial Genetic Testing Program effective 6/1/2018
Age-related macular degeneration (AMD) is a complex disease involving both genetic and environmental (e.g., smoking) influences. Macular degeneration is the leading cause of severe vision loss in people older than age 60 and occurs when the central portion of the retina, the macula, deteriorates. AMD is divided into the dry form, associated with slowly progressive vision loss, and the wet form, which may be associated with rapidly progressive and severe vision loss.
Testing for mutations at certain genetic loci has been proposed to predict the risk of developing advanced AMD or to guide treatment. The clinical utility of genetic testing for AMD is currently limited. There are no preventive measures that can be undertaken outside of good health practices and no known association between specific genotypes and specific therapies.
Genetic testing for macular degeneration is considered investigational.
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.
There is a lack of high-quality studies that show improvements in health outcomes in individuals identified as being at high risk based on genetic testing.
American Academy of Ophthalmology. (February 2014). Recommendations of the American Academy of Ophthalmology task force on genetic testing. Retrieved August 6, 2015 from http://www.aao.org.
Blue Cross BlueShield Association. Evidence Positioning System. (3:2018). Genetic testing for macular degeneration (2.04.103). Retrieved March 8, 2019 from http://www.evidencepositioningsystem.com. (16 articles and/or guidelines reviewed)
CMG.gov: Center for Medicare & Medicaid Services. Palmetto, GBA. (2019, January) MolDX: Molecular Diagnostic Tests (MDT). (LCD ID L35025). Retrieved March 8, 2019 from http://www.cms.gov.
Csaky, K., Schachat, A., Kaiser, P., Small, K., & Heier, J. (2017). The use of genetic testing in the management of patients with age-related macular degeneration: American Society of Retina Specialists genetics task force special report. Journal of VitreoRetinal Diseases, 1 (1), 75-78. (Level 2 evidence)
Hagstrom, S., Ying, G., Maguire, M., Martin, D., Gibson, J., Lotery, A., & Chakravarthy, U. (2015). VEGFR2 gene polymorphisms and response to anti-VEGF therapy in age-related macular degeneration. Ophthalmology, 122 (8), 1563-1568. (Level 3 evidence)
Hagstrom, S., Ying, G., Pauer, G., Sturgill-Short, G., Huang, J., Maguire, M., & Martin, D. (2014). VEGF-A and VEGFR-2 gene polymorphisms and response to anti-VEGF therapy in the comparison of AMD treatments trials (CATT). JAMA Ophthalmology, 132 (5), 521-527. (Level 3 evidence)
ORIGINAL EFFECTIVE DATE: 5/10/2014
MOST RECENT REVIEW DATE: 4/11/2019
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