News


Cigna Updates Genetic Testing Policy

After extensive and positive discussions between CIGNA and the leadership of ASBrS, we are pleased to let you know that the previous CIGNA policy requiring consultation with an independent genetic counselor prior to the ordering of genetic testing has been changed.  The new policy, which became effective January 15th 2018, states that breast surgeons are no longer required to obtain pretest genetic counseling when ordering cancer susceptibility genetic testing for certain clinical scenarios. The waiver of the pre-test genetic counseling requirement is only applicable when the results of testing are pressing and will influence the surgical decision making for an individual recently diagnosed with early stage breast cancer. Please note that the requirements for precertification of this testing otherwise remain the same.

Breast surgeons who plan to order their own testing will be asked to: 

  • Evaluate the patient
  • Perform a three-generation pedigree [This can be accomplished via Mastery of Breast Surgery Risk Calculator available to you for free as a member]
    and
  • For a patient with recently diagnosed breast cancer, plan to refer to an appropriately credentialed independent genetic counselor for post-test counseling
  • Submit a precertification request utilizing the genetic testing precertification form*.

While historically Cigna had coverage policies only surrounding and supportive of individual genetic tests, they are in the process of expanding their position to cover particular “panels” of genetic tests. Please consult with Cigna for the most up to date list of panels that will be covered if medically necessary. As of February 1, 2018, the two hereditary cancer genetic testing panels which are currently under contract with Cigna are Color by Color Genomics and the Limited Breast Cancer Panel from Myriad.

This represents a positive step forward for CIGNA in their recognition of the need for rapid testing in patients awaiting surgery. We will continue to engage with CIGNA and other payers on issues that affect our patients and practices.  

The full policy can be found here:  https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0518_coveragepositioncriteria_genetic_cancer_syndromes.pdf.

Please feel free to contact Mena Jalali at mjalali@breastsurgeons.org with issues that you may encounter or with questions.

*Cigna Genetic Testing Recommendation Form