1. Aetna considers genetic counseling in connection with pregnancy management medically necessary for evaluation of any of the following:
   
   
   1. Couples who are closely related genetically (consanguinity, incest); or
   2. Familial cancer disorders; or
   3. Individuals from ethnic groups recognized to be at increased risk for specific genetic disorders (e.g., African Americans for sickle cell anemia, Ashkenazi [eastern European] Jews for Tay-Sachs disease); or
   4. Infertility cases where either parent is known to have a chromosomal abnormality; or
   5. Individuals with primary amenorrhea, azospermia, abnormal sexual development or failure in developing secondary sexual characteristics; or
   6. Mother, known, or presumed carrier of an X-linked recessive disorder; or
   7. One or both parents are known carriers of an autosomal recessive disorder; or
   8. Parents of a child born with a genetic disorder, birth defect, inborn error of metabolism or chromosome abnormality; or
   9. Parents of a child with mental retardation, autism, developmental delays, or learning disabilities; or
   10. Pregnant women who, based on prenatal ultrasound tests or an abnormal multiple marker screening test, maternal serum alpha-fetoprotein (AFP) test, test for sickle cell anemia, or tests for other genetic abnormalities have been told their pregnancy may be at increased risk for complications or birth defects; or
   11. Pregnant women with maternal age 35 years or greater at delivery; or
   12. Pregnant women, or women planning pregnancy, exposed to potentially teratogenic, mutagenic or carcinogenic agents (i.e., chemicals, drugs, infections, radiation); or
   13. Previous unexplained stillbirth or repeated (3 or more; 2 or more among infertile couples) first trimester miscarriages, where there is suspicion of parental or fetal chromosome abnormalities; or
   14. When contemplating pregnancy, either parent affected with an autosomal dominant disorder.

   Note: Genetic counseling for pregnancy management may not be covered under plans that exclude family planning benefits.  Please check benefit plan descriptions for details.

2. Aetna considers appropriate genetic counseling unrelated to pregnancy medically necessary for consideration of, or provided in conjunction with, medically necessary genetic testing, and in accordance with the guidelines of the American College of Medical Genetics (ACMG).
3. Aetna considers genetic counseling experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established. 

See also CPB 0140 - Genetic Testing.

Genetic counseling is a process of communication between patients and trained professionals intended to provide patients who have a genetic disease, or risk of such a disease, with information about their condition and its effect on their family.  This allows patients and their families to make informed reproductive and other medical decisions.  The counselor will evaluate medical problems or risks present in a family, analyze and explain inheritance patterns of any disorders found, provide information about management and treatment of these disorders, and discuss available options with the family or individual.

According to the American College of Medical Genetics, an important issue in genetic testing is defining the scope of informed consent.  The obligation to counsel and obtain consent is inherent in the clinician-patient and investigator-subject relationships.  In the case of most genetic tests, the patient or subject should be informed that the test might yield information regarding a carrier or disease state that requires difficult choices regarding their current or future health, insurance coverage, career, marriage, or reproductive options.  The objective of informed consent is to preserve the individual's right to decide whether to have a genetic test.  This right includes the right of refusal should the individual decide the potential harm outweighs the potential benefits.

Moyer (2014) noted that the U.S. Preventive Services Task Force (USPSTF) reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA mutations in asymptomatic women with a family history of breast or ovarian cancer but no personal history of cancer or known potentially harmful BRCA mutations in their family.  The USPSTF also reviewed interventions aimed at reducing the risk for BRCA-related cancer in women with potentially harmful BRCA mutations, including intensive cancer screening, medications, and risk-reducing surgery.  This recommendation applies to asymptomatic women who have not been diagnosed with BRCA-related cancer.  The USPSTF recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with 1 of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2).  Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing (B recommendation).  The USPSTF recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes (D recommendation).