{"id":6409,"date":"2021-03-30T15:24:28","date_gmt":"2021-03-30T15:24:28","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=6409"},"modified":"2021-03-30T16:55:54","modified_gmt":"2021-03-30T16:55:54","slug":"clinical-review-criteria-preimplantation-genetic-testing-for-monogenic-single-gene-defects-pgt-m","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-preimplantation-genetic-testing-for-monogenic-single-gene-defects-pgt-m\/","title":{"rendered":"Clinical Review Criteria Update &#8211; Preimplantation Genetic Testing for Monogenic\/Single Gene Defects (PGT-M)"},"content":{"rendered":"<p>Policy Number:\u00a0UM481POL<br \/>\nEffective Date:\u00a06\/1\/2021<br \/>\nLOB Affected: Commercial<br \/>\nPolicy Type: Medical<\/p>\n<p><strong>Title of Policy changed:<\/strong><\/p>\n<p><em>From:<\/em>\u00a0 Preimplantation Genetic Testing (PGT) \/ Preimplantation Genetic Diagnosis (PGD)<\/p>\n<p><em>To:<\/em>\u00a0 Preimplantation Genetic Testing for Monogenic\/Single Gene Defects (PGT-M)<\/p>\n<p><em>Definitions:\u00a0<\/em><\/p>\n<ul>\n<li>Eliminated Preimplantation Genetic Diagnosis (PGD)<\/li>\n<li>Added under Preimplantation Genetic Testing for Aneuploidy (PGTA): Not covered by HNE<\/li>\n<li>Removed definition of PGT-A<\/li>\n<li>Added definitions of Autosomal Recessive Disorder; and Autosomal Dominant Disorder<\/li>\n<\/ul>\n<p><em><br \/>\nLocated Below Medical Criteria Disclaimer:<\/em><\/p>\n<p>\u201cPreimplantation Genetic Testing (PGT)<u>\/Preimplantation Genetic Diagnosis (PGD)<\/u> is used in conjunction \u2026\u201d:\u00a0 Removed the underlined.<\/p>\n<ul>\n<li>Located Above I., Criteria for Approval<\/li>\n<\/ul>\n<p><strong><em>\u00a0\u00a0 Added:<\/em><\/strong>\u00a0 \u201c***Any state mandates for genetic testing take precedence over this policy.***\u201d<\/p>\n<ul>\n<li>I, Criteria for Approval. Section re-worded:<\/li>\n<\/ul>\n<ul>\n<li>Added A. (below) followed by 3 criteria:\u201cA., PGT-M may be medically necessary including IVF with\/without ICSI including members that are not infertile when the following criteria are met:\u201d<\/li>\n<\/ul>\n<ul>\n<li>Added B.:<\/li>\n<\/ul>\n<p><em><strong><br \/>\nAdded statement followed by 4 criteria<\/strong><\/em><\/p>\n<ul>\n<li>II.<\/li>\n<li>Changed PGD to PGTM: \u201cPGTM should only be offered in centers \u2026\u201d<\/li>\n<li>Added A., MEDICALLY NECESSARY diagnoses included but are not limited to the following:<\/li>\n<li>III., Required Documentation: Section relabeled from II. to III.<\/li>\n<li>IV., What is Not Covered:<br \/>\nA., Changed PGD to PGT-A<\/li>\n<li>CPT Codes: Added 89398 which is E&amp;I for this policy<\/li>\n<li>Source\/Citation Section: Added 3 sources\/citations<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Policy Number:\u00a0UM481POL Effective Date:\u00a06\/1\/2021 LOB Affected: Commercial Policy Type: Medical Title of Policy changed: From:\u00a0 Preimplantation Genetic Testing (PGT) \/ Preimplantation Genetic Diagnosis (PGD) To:\u00a0 Preimplantation Genetic Testing for Monogenic\/Single Gene Defects (PGT-M) Definitions:\u00a0 Eliminated Preimplantation Genetic Diagnosis (PGD) Added under Preimplantation Genetic Testing for Aneuploidy (PGTA): Not covered by HNE Removed definition of PGT-A [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":4990,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[],"class_list":["post-6409","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2019\/12\/GettyImages-177308250.jpg?fit=724%2C483","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1Fn","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6409","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=6409"}],"version-history":[{"count":6,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6409\/revisions"}],"predecessor-version":[{"id":6428,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6409\/revisions\/6428"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/4990"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=6409"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=6409"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=6409"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}