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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.

ID Title Last Review Next Review Description Access
11.003.037 Novel Biomarkers In Risk Assessment And Management Of Cardiovascular Disease Jan 20, 2025 Jan 20, 2026 Numerous lipid and non-lipid biomarkers have been proposed as potential risk markers for cardiovascular... View
11.003.038 Biomarker Genes For Detection Of Lymph Node Metastases In Breast Cancer May 15, 2019 Policy Archived As highlighted in a 2008 editorial, the ongoing difficulties with using molecular techniques to detect... View
11.003.039 Pharmacogenomic And Metabolite Markers For Patients Treated With Thiopurines Dec 20, 2024 Dec 20, 2025 The thiopurine class of drugs, which include azathioprine (a pro-drug for mercaptopurine), mercaptopurine,... View
11.003.040 Genetic Testing For Alzheimer Disease Nov 22, 2024 Nov 20, 2025 Alzheimer disease (ad) is the most common cause of dementia in elderly patients. for late-onset ad, there is... View
11.003.042 Genetic Testing For Cardiac Ion Channelopathies Feb 18, 2025 Feb 20, 2026 Genetic testing is available for patients suspected of having cardiac ion channelopathies, including long qt... View
11.003.046 Genetic Testing For Fmr1 Variants (Including Fragile X Syndrome) Feb 20, 2025 Feb 20, 2026 Fragile x syndrome (fxs) is the most common inherited form of mental disability and a known genetic cause of... View
11.003.047 Gene Expression-Based Assays For Cancers Of Unknown Primary Apr 15, 2024 Apr 20, 2025 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 Oct 10, 2024 Oct 20, 2025 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 Aug 20, 2024 Aug 20, 2025 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 10, 2025 Mar 20, 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 Oct 08, 2024 Oct 20, 2025 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 24, 2024 Sep 20, 2025 To determine which patients need thyroid resection, many physicians will perform a cytologic examination of... View
11.003.053 Whole Exome And Whole Genome Sequencing For Diagnosis Of Genetic Disorders Apr 18, 2024 Apr 20, 2025 Whole exome sequencing (wes) sequences the portion of the genome that contains protein-coding dna, while... View
11.003.056 Genetic Testing For A Thalassemia Jul 10, 2024 Jul 20, 2025 Alpha-thalassemia represents a group of clinical syndromes of varying severity characterized by hemolytic... View
11.003.057 Genetic Testing For Fanconi Anemia Jan 15, 2025 Jan 20, 2026 Fanconi anemia (fa) is an inherited disorder characterized by congenital abnormalities, bone marrow failure,... View
11.003.059 Genetic Testing For Hereditary Pancreatitis Mar 10, 2025 Mar 20, 2026 ... View
11.003.060 Genetic Testing For Flt3, Npm1, And Cebpa Variants In Cytogenetically Normal Acute Myeloid Leukemia Feb 20, 2025 Feb 20, 2026 Treatment of acute myeloid leukemia (aml) is based on risk stratification, primarily related to patient age... View
11.003.062 General Approach To Genetic Testing Jan 21, 2025 Jan 20, 2026 Commercially available genetic tests can perform a host of functions, such as providing a guided intervention... View
11.003.063 Bcr-Abl1 Testing In Chronic Myelogenous Leukjemia And Acute Lymphoblastic Leukemia Dec 03, 2024 Nov 20, 2025 In the treatment of philadelphia chromosome-positive leukemias, various nucleic acid-based laboratory methods... View
11.003.064 Genetic Cancer Susceptibility Panels Using Next Generation Sequencing Dec 12, 2024 Nov 20, 2025 Commercially available cancer susceptibility gene panels can test for multiple variants associated with a... View

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