About this policy
Jurisdiction: J5 MAC Part B. States: Iowa, Kansas, Missouri, Nebraska. Type: Active LCD
Coverage indications
This policy provides limited coverage for methylation analysis for hypermethylation of the O-6methylguanine DNA methyltransferase (MGMT) gene promoter. MGMT methylation analysis testing is considered to be reasonable and necessary for adult patients when the following criteria are met: Tumor type is high-grade malignant glioma (e.g. glioblastoma multiforme (GBM), anaplastic astrocytoma) and Patients are able to tolerate temozolomide therapy or radiation therapy, and The physician will use the MGMT testing results to decide between radiation therapy and chemotherapy alone as 1st line adjuvant treatment, or between temozolomide and other chemotherapy for 1st line adjuvant treatment Note: This assessment is predicated on the assumption that therapy is considered beneficial for the specific patient.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.