MP.116.MPC – Genetic Testing for Cystic Fibrosis
Policy Number: MP.116.MPC
Last Review Date: 05/19/2022
Effective Date: 06/01/2022
MP.116.MPC ¨C Genetic Testing for Cystic Fibrosis
Maryland Physician sCare considers Genetic Testing for Cystic Fibrosis (CF)
medically necessary for the following indications:
Genetic testing for CF is considered medically necessary when any of the following
criteria are met:
? Couples planning a pregnancy or seeking prenatal care
? Persons with a family history of CF
? Persons with a first degree relative identified as a CF carrier
? Reproductive partners of persons with CF or are carriers of CF
Or
? Diagnostic purposes
1. A clinical presentation of CF and a negative/equivocal sweat test
2. Infant with meconium ileus or other symptoms indicative of CF who are
too young to produce adequate amounts of sweat for a sweat chloride
test
3. Infant with elevated immunoreactive trypsinogen (IRT) value on newborn
screening with no clinical suspicion of CF
4. Male infertility in the father from either congenital bilateral absence of vas
deferens (CBAVD) or azoospermia or severe oligospermia (i.e. ................
................
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