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 |
|---|---|---|---|---|---|
| 11.003.032 | Analysis Of Human Dna In Stool Samples As A Technique For Colorectal Cancer Screening | Jan 20, 2025 | Jan 20, 2026 | Of safety and effectiveness data (ssed): cologuard. august 2014. accessed oct 21,... | View |
| 11.003.033 | Análisis de los patrones proteómicos séricos para identificar el cáncer de ovari | May 12, 2016 | Policy Archived | ... | View |
| 11.003.034 | Genetic And Protein Biomarkers For The Diagnosis And Cancer Risk Assessment Of Prostate Cancer | Dec 20, 2024 | Dec 20, 2025 | Various genetic and protein biomarkers are associated with prostate cancer. these tests have the potential to... | View |
| 11.003.035 | Assays Of Genetic Expression In Tumor Tissue As A Technique To Determine Prognosis In Patients With Breast Cancer | Dec 06, 2024 | Dec 20, 2025 | Laboratory tests have been developed to detect the expression, via messenger rna, of different genes in... | View |
| 11.003.036 | Genetic Testing For Familial Cutaneous Malignant Melanoma | Apr 18, 2025 | Apr 20, 2026 | Cutaneous melanoma is the third most common type of skin cancer, but the most lethal. some cases of cutaneous... | View |
| 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 | May 09, 2025 | May 20, 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 | 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 | Apr 14, 2025 | Apr 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 | May 05, 2025 | May 20, 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 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 22, 2025 | Apr 20, 2026 | 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 |
