Yes JAG1 (Alagille syndrome) full gene sequence – any The patient has clinical features suspicious Molecular Pathology – provider, for, or requires the service as a confirmatory Procedure, Level 8 except with test for Alagille syndrome valid TAR NOTCH (notch 1) full gene sequence The – – override patient has suspected or confirmed acute lymphoblastic leukemia, and the result of the test will influence the diagnosis, prognosis and/or therapeutic management NPHS1 (congenital Finnish nephrosis) The patient has clinical diagnosis of steroid-resistant nephritic syndrome (SRNS)/congenital Finnish nephrosis, and Treatment will be contingent on the test results SCN1A The patient has clinical features suspicious – for, or requires the service as a confirmatory test for Dravet syndrome SPTBN2 (spinocerebellar ataxia) The patient has – clinical features suspicious for, or requires the service as a confirmatory test for spinocerebellar ataxia Claims without documentation showing the preceding criteria have been met will be denied.
Molecular Pathology Procedure, Level 8 Yes JAG1 (Alagille syndrome) – full gene sequence – The patient has clinical features suspicious for, or requires the service as a confirmatory test for Alagille syndrome NOTCH (notch 1) – full gene sequence – The patient has suspected or confirmed acute lymphoblastic leukemia, and the result of the test will influence the diagnosis, prognosis and/or therapeutic management NPHS1 (congenital Finnish nephrosis) The patient has clinical diagnosis of steroid-resistant nephritic syndrome (SRNS)/congenital Finnish nephrosis, and Treatment will be contingent on the test results SCN1A – The patient has clinical features suspicious for, or requires the service as a confirmatory test for Dravet syndrome SPTBN2 (spinocerebellar ataxia) – The patient has clinical features suspicious for, or requires the service as a confirmatory test for spinocerebellar ataxia Claims without documentation showing the preceding criteria have been met will be denied. any provider, except with valid TAR override