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 |
|---|---|---|---|---|---|
| 11.003.052 | Molecular Markers In Fine Needle Aspirates Of The Thyroid | Sep 02, 2025 | Sep 20, 2026 | 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 15, 2025 | Jul 20, 2026 | 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 |
| 11.003.066 | Genetic Testing For Duchenne And Becker Muscular Dystrophy | Apr 10, 2025 | Apr 20, 2026 | Variants in the duchenne muscular dystrophy (dmd) gene, which encodes the protein dystrophin, may result in a... | View |
| 11.003.067 | Genotype-Guided Warfarin Dosing | Jul 11, 2025 | Jul 20, 2026 | Using information about an individual's genotype may help in guiding warfarin dosing and could reduce... | View |
| 11.003.068 | Genetic Testing For The Diagnosis Of Inherited Peripheral Neuropathies | Feb 20, 2025 | Feb 20, 2026 | Description the inherited peripheral neuropathies are a heterogeneous group of diseases that may be inherited... | View |
| 11.003.069 | Analysis Of Mgmt Promoter Methylation In Malignant Gliomas | Jun 13, 2019 | Policy Archived | Testing for o6-methylguanine-dna methyltransferase (mgmt) gene promoter methylation has been proposed as a... | View |
| 11.003.070 | Preimplantation Genetic Testing | Sep 05, 2025 | Sep 20, 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 20, 2025 | Mar 20, 2026 | Marfan syndrome (mfs) is a systemic connective tissue disease (ctd) with a high degree of clinical... | View |
| 11.003.073 | Laboratory And Genetic Testing For Use Of 5-Fluorouracil In Patients With Cancer | Apr 18, 2025 | Apr 20, 2026 | Variability in systemic exposure to 5-fluorouracil chemotherapy is thought to directly impact 5-fluorouracil... | View |
| 11.003.075 | Proteomic Testing For Targeted Therapy In Non-Small-Cell Lung Cancer | Dec 06, 2024 | Dec 20, 2025 | Proteomic testing has been proposed as a way to predict survival outcomes, as well as the response to and... | View |
| 11.003.076 | Multibiomarker Disease Activity Blood Test For Rheumatoid Arthritis | Jul 11, 2025 | Jul 20, 2026 | Assessment of disease activity in rheumatoid arthritis (ra) is an important component of management with a... | View |
| 11.003.077 | Los ensayos de varios analitos con el análisis algorítmico para predecir el ries | Oct 11, 2016 | Policy Archived | ... | View |
| 11.003.078 | Noninvasive Prenatal Screening For Fetal Aneuploidies And Microdeletions Using Cell-Free Fetal Dna | Apr 22, 2025 | Apr 20, 2026 | National guidelines recommend that all pregnant individuals be offered screening for fetal chromosomal... | View |
