What Our Clients Want to Know: BART Testing: What are marketplace standards in coverage?

Posted by The Evidence Blog on May 5, 2015

As the second most commonly diagnosed cancer among women, breast cancer represents nearly 30% of all cancers detected in women. Only a small fraction of these cancers are caused by harmful changes in specific genes. Variants in the BRCA1 and BRCA2 genes represent the most common causes of genetic breast cancer in women. BRCA testing can identify small alterations in DNA sequencing, but it does not detect all variants that may cause breast cancer, including large sequencing errors.

 

BART (BRACAnalysis Large Rearrangement Test) was developed to evaluate for major sequencing errors known as rearrangements that are not detectable by comprehensive BRCA testing. Although BART can be performed as a stand-alone test, it is predominantly done following a negative BRCA test result.

Recently, a client requested a review of marketplace standards in covering BART. We found that large health plans vary on their coverage policies. Some payers consider BART to be investigational and thus deny coverage. Others have established a set of qualifying criteria for coverage, such as:

  • Recommendation by a certified geneticist, genetic nurse, or genetic counselor
  • Test result from standard BRCA1 and BRCA2 is negative
  • Known familial BRCA1 or BRCA2 large rearrangement variant

Some health plans state that testing for large rearrangement variants is medically necessary but do not specifically mention BART as the vehicle for testing. Currently, there is no Centers for Medicare & Medicaid Services (CMS) National Coverage Determination (NCD) that addresses BART; therefore, local coverage is at the discretion of local Medicare carriers. Furthermore, the National Comprehensive Cancer Network (NCCN) recommends large genomic rearrangement testing for individuals who meet certain hereditary breast cancer criteria but does not cite BART by name.

The cost of the BART test is approximately $700.

Interested in additional information regarding breast cancer screening options? Check out the following link (click here).

Topics: Hayes Blog

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