Medical Policies

Medical policies are documents that define the plan coverage for technologies, procedures and treatments. The statements of medical necessity in the policies, about whether a technology, procedure, treatment, supply, equipment, drug or other service improves the health outcome of the population for which said technology or treatment was designed are based on scientific evidence, clinical studies and professional opinions from our providers and recognized medical organizations.

Each document displayed on this website is provided for informational purposes only and is not an authorization, explanation of benefits, or contract. Receiving benefits is subject to satisfaction of all terms and conditions of coverage. Medical technology is constantly changing, and we reserve the right to periodically review and update our policies.

Medical Policies table

ID Title Review Description Access
11.003.015 Gene Expression Profile Testing And Circulating Tumor Dna Testing For Predicting Recurrence In Colon Cancer Sep 2026 Gene expression profile (gep) and tumor-naïve circulating tumor dna (ctdna) tests have been developed... View
11.003.016 Genetic Testing For Pten Hamartoma Tumor Syndrome Mar 2026 The pten hamartoma tumor syndrome (phts) includes several syndromes with heterogeneous clinical symptoms,... View
11.003.017 Genetic Testing For Hereditary Hearing Loss May 2026 Hearing loss is a common birth defect. approximately 1 in 500 newborns in developed countries is affected by... View
11.003.018 Chromosomal Microarray Testing For The Evaluation Of Pregnancy Loss Sep 2026 Chromosomal microarray (cma) testing of fetal tissue or placental tissue derived from the fetal genotype has... View
11.003.026 Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies Sep 2026 Comprehensive genetic profiling offers the potential to evaluate a large number of genetic markers at a... View
11.003.027 Gene Variants Associated With Breast Cancer In Individuals At High Breast Cancer Risk. Sep 2026 It is estimated that 3% to 5% of women presenting for assessment for hereditary breast/ovarian cancer risk... View
11.003.030 Genetic Testing For Brca1 Or Brca2 For Hereditary Breast/Ovarian Cancer Syndrome And Other High-Risk Cancers Sep 2026 <h2 style="break-inside: avoid; break-after: avoid; font-family: arial; font-size: 20px !important;... View
11.003.037 Analyte Testing in Risk Assessment and Management of Cardiovascular Disease Sep 2026 Numerous lipid and non-lipid biomarkers have been proposed as potential risk markers for cardiovascular... View
11.003.047 Gene Expression-Based Assays For Cancers Of Unknown Primary May 2026 Cancers of unknown primary represent 3% to 4% of cancers diagnosed in the united states. these cancers are... View
11.003.048 Carrier Screening For Genetic Diseases Sep 2026 Carrier screening is performed to identify individuals at risk of having offspring with inherited recessive... View
11.003.049 Genetic Testing For Diagnosis And Management Of Mental Health Conditions Sep 2026 Individual genes have been shown to be associated with the risk of psychiatric disorders and specific aspects... View
11.003.050 Genetic Testing For Epilepsy Mar 2026 Epilepsy is a disorder characterized by unprovoked seizures. it is a heterogeneous condition that encompasses... View
11.003.051 Gene Expression Profiling And Protein Biomarkers For Prostate Cancer Management Jul 2026 Gene expression profile analysis and protein biomarkers have been proposed as a means to risk-stratify... View
11.003.052 Molecular Markers In Fine Needle Aspirates Of The Thyroid Sep 2026 To determine which patients need thyroid resection, many physicians will perform a cytologic examination of... View
11.003.056 Genetic Testing For A Thalassemia Sep 2026 Alpha-thalassemia represents a group of clinical syndromes of varying severity characterized by hemolytic... View
11.003.059 Genetic Testing For Hereditary Pancreatitis Mar 2026 ... View
11.003.064 Genetic Cancer Susceptibility Panels Using Next Generation Sequencing Sep 2026 Commercially available cancer susceptibility gene panels can test for multiple variants associated with a... View
11.003.066 Genetic Testing For Duchenne And Becker Muscular Dystrophy Apr 2026 Variants in the duchenne muscular dystrophy (dmd) gene, which encodes the protein dystrophin, may result in a... View
11.003.070 Preimplantation Genetic Testing Sep 2026 Preimplantation genetic testing involves the analysis of biopsied cells as part of an assisted reproductive... View
11.003.072 Genetic Testing For Marfan Syndrome, Thoracic Aortic Aneurysms And Dissections, And Related Disorders Mar 2026 Marfan syndrome (mfs) is a systemic connective tissue disease (ctd) with a high degree of clinical... View