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Hereditary Cancer

Family history is the least reliable reliable thing in a chart.

Ask a patient about their family's cancer history twice, a year apart, and you will often get two different answers. Ages get misremembered. "Some kind of cancer" stands in for a specific diagnosis. A cousin becomes an aunt. It's not a data quality problem you can train your way out of. And yet plenty of testing workflows still treat family history as the gate: no family history, no referral, no test.

PEDIGREE AS DOCUMENTED ? ? ? Proband Affected, documented History unverified Patient in front of you 3 of 6 relatives never confirmed
Standard pedigree notation: squares male, circles female, filled indicates an affected relative. Pulsing outlines mark relatives whose history was never confirmed.

Family history is supportive, not a sole qualifier

ScreenMyGene doesn't wait for a clean family history to consider a hereditary cancer panel, and it doesn't stop at a vague one either. Personal history — prior diagnoses, age at onset, tumor characteristics documented in the chart — carries real weight on its own. Family history strengthens or weakens the case; it doesn't singlehandedly decide it. That distinction matters most for exactly the patients most likely to be missed: the ones whose relatives were never tested, never diagnosed, or simply never talked about it.

SIGNALS WEIGHTED SEPARATELY Personal history Early onset · tumour pathology · prior diagnoses Family history Partial — supportive, not decisive THRESHOLD Qualifies on personal history alone
Personal and family history contribute independently. A well-documented personal history can carry the recommendation across the threshold on its own.

How it works for hereditary cancer specifically

1. Personal and family history extraction — Diagnoses, ages at onset, and relevant family history are pulled from the chart and structured rather than left as free text.

2. Criteria matching — Extracted history is evaluated against professional-society testing criteria for the relevant syndromes.

3. Confidence-weighted panel selection — Personal and family history findings are weighted separately. A strong personal history can qualify a panel with a thin family history; a strong family history can flag a panel worth confirming even with limited personal findings.

4. ICD-10 and coverage check — The recommendation is anchored to a documented, matching diagnosis code and checked against Medicare LCD/NCD coverage policy.

What this catches that a family-history checklist misses

NOT ONE SYNDROME Breast & ovarianpersonal + family Lynch syndromecolorectal · endometrial Other syndromesas history supports Panel matched to what the chart supports
Panel selection follows the syndrome the documented history points to, rather than defaulting to a single familiar gene pair.

Who this is for

See how personal and family history combine into one recommendation.

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Hereditary cancer testing that survives coverage review

Medicare covers germline NGS for qualifying breast and ovarian cancer patients nationally under NCD 90.2 — but most hereditary-cancer coverage runs through professional-society criteria and local determinations, and denial rates for advanced genetic testing have climbed past 27%. Panels anchored to documented personal and family history, with a matching diagnosis code attached, are the difference between an order and an appeal.

27%of advanced genetic testing claims denied — nearly 2x higher at independent labs
NCD 90.2national Medicare coverage rule for NGS in qualifying inherited cancers
Z80.x / Z85.xthe family- and personal-history code families that establish medical necessity

Common questions

When does hereditary cancer testing qualify for coverage?

When the documented personal and family history meets the payer's testing criteria - typically aligned to professional-society guidance - and the claim carries a specific, matching ICD-10-CM code rather than a generic encounter code.

Is family history alone enough to qualify a panel?

It is treated as a supportive factor, not a sole qualifier. The recommendation stands on the full documented picture: personal history, family history, and applicable testing criteria together.

What is NCD 90.2?

Medicare's national coverage rule for next-generation sequencing: germline NGS is covered nationally for qualifying breast and ovarian cancer patients, with MAC discretion for other cancers, when run in a CLIA-certified lab and ordered by the treating physician.

Medicare coverage guideICD-10 coding guideDenial prevention