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
11.003.014 Noninvasive Fetal Rhd Genotyping Using Cell-Free Fetal Dna Sep 2026 Rhesus d (rhd)-negative women who are exposed to rhd-positive red blood cells can develop anti-rhd... View
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
11.003.020 Genetic Testing For Lactase Insufficiency Jul 2024 Genetic testing of adults with suspected lactase insufficiency is proposed as an alternative to current... View
11.003.021 Gene Expression Testing In The Evaluation Of Patients With Stable Ischemic Heart Disease Apr 2021 Expression levels of various genes in circulating white blood cells or whole blood samples have been reported... View
11.003.022 Genetic Testing For Li-Fraumeni Syndrome Aug 2026 Li-fraumeni syndrome (lfs) is a cancer predisposition syndrome associated with the development of several... View
11.003.025 Genetic Testing For Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, And Congenital Anomalies Nov 2025 Chromosomal microarray (cma) testing has been proposed for the detection of genetic imbalances in infants or... 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
11.003.028 Genetic Testing For Lynch Syndrome And Other Inherited Colon Cancer Syndromes Oct 2026 Genetic testing is available for both those with and those at risk for various types of hereditary cancer.... View
11.003.029 Epithelial Cell Cytology In Breast Cancer Risk Assesment And High-Risk Patient Management (Ductal Labage And Suction Collection Systems) May 2019 In summary, the available literature regarding ductal lavage and suction collection systems for breast cancer... 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
11.003.031 Genetic Testing For Hereditary Hemochromatosis Jun 2026 Hereditary hemochromatosis (hh), a common genetic disorder of iron metabolism, can lead to inappropriate iron... View
11.003.032 Analysis Of Human Dna In Stool Samples As A Technique For Colorectal Cancer Screening Jan 2026 Of safety and effectiveness data (ssed): cologuard. august 2014. accessed oct 23,... View
11.003.034 Genetic And Protein Biomarkers For The Diagnosis And Cancer Risk Assessment Of Prostate Cancer Aug 2026 Various genetic and protein biomarkers are associated with prostate cancer. these tests have the potential to... View
11.003.036 Genetic Testing For Familial Cutaneous Malignant Melanoma Apr 2026 Cutaneous melanoma is the third most common type of skin cancer, but the most lethal. some cases of cutaneous... 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
11.003.039 Pharmacogenomic And Metabolite Markers For Patients Treated With Thiopurines Dec 2025 The thiopurine class of drugs, which include azathioprine (a pro-drug for mercaptopurine), mercaptopurine,... View