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
11.003.076 Multibiomarker Disease Activity Blood Test For Rheumatoid Arthritis Jul 2026 Assessment of disease activity in rheumatoid arthritis (ra) is an important component of management with a... View
11.003.078 Noninvasive Prenatal Screening For Fetal Aneuploidies And Microdeletions Using Cell-Free Fetal Dna Apr 2026 ... View
11.003.079 Invasive Prenatal (Fetal) Diagnostic Testing Sep 2026 Invasive prenatal (fetal) diagnostic testing may be used to identify pathogenic genetic alterations in... View
11.003.081 Genetic Testing For Macular Degeneration Apr 2026 Age-related macular degeneration is a complex disease involving both genetic and environmental influences.... View
11.003.082 Genetic Testing For Facioscapulohumeral Muscular Dystrophy Mar 2026 Facioscapulohumeral muscular dystrophy (fshd) is an autosomal dominant disease that typically presents before... View
11.003.083 Genetic Testing For Charge Syndrome Mar 2026 Charge syndrome is a rare genetic condition associated with multiple congenital anomalies. in many... View
11.003.084 Genetic Testing For Idiopathic Dilated Cardiomyopathy Mar 2026 Dilated cardiomyopathy (dcm) is characterized by progressive left ventricular enlargement and systolic... View
11.003.089 Circulating Tumor Dna And Circulating Tumor Cells For Cancer Management (Liquid Biopsy) Jul 2026 Circulating tumor dna (ctdna) and circulating tumor cells (ctcs) in peripheral blood, referred to as... View
11.003.092 Proteogenomic Testing For Patients With Cancer Jul 2026 Proteogenomics refers to the integration of genomic information with proteomic and transcriptomic information... View
11.003.094 Serum Biomarket Panel Testing For Systemic Lupus Erythematosus And Other Connective Tissue Deseases Sep 2026 Systemic lupus erythematosus (sle) is an autoimmune connective tissue disease (ctd) that can be difficult to... View
11.003.106 Genetic Testing For Heterozygous Familial Hypercholesterolemia Sep 2026 Complete appendix to guidelines available at http://journals.aace.com. endocr pract. apr 02 2017; 23(4):... View
11.003.107 Genetic Testing For Hereditary Pancreatic Cancer Mar 2026 Pancreatic cancer is the fourth leading cause of cancer death in the united states, accounting for 8.3% of... View
11.003.108 Measurement Of Serum Antibodies To Selected Biologic Agent Sep 2026 Biologic agents used to treat autoimmune diseases include infliximab, adalimumab, vedolizumab, and... View
11.003.135 Genetic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Advanced Cancer Jul 2026 Multiple biomarkers are being evaluated to select treatment with an fda-approved targeted treatments for... View
11.003.137 Germline Genetic Testing for Hereditary Diffuse Gastric Cancer (CDH1, CTNNA1) Sep 2026 Hereditary diffuse gastric cancer (hdgc, sometimes called signet ring gastric cancer) is an autosomal... View
11.003.141 Laboratory Testing Investigational Services Sep 2026 There are numerous commercially available genetic and molecular diagnostic, prognostic, and therapeutic tests... View
11.003.142 Circulating Tumor-Tissue-Modified Viral DNA Testing Apr 2026 This evidence review addresses the use of circulating tumor-tissue-viral modified (ttmv) human papillomavirus... View
13.009.004 Temporomandibular Joint Disorder Mar 2026 Temporomandibular joint disorder (tmjd) refers to a group of disorders characterized by pain in the... View
99.001.001 Gene Therapies for Duchenne Muscular Dystrophy Apr 2026 Duchenne muscular dystrophy (dmd) is an inherited disorder that results in progressive muscle weakness and... View
99.999.999 List of Retired Policies Sep 2026 List of retired... View