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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 |
|---|---|---|---|---|---|
| 11.003.064 | 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 08, 2024 | Jul 20, 2025 | 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 | Dec 06, 2024 | Sep 20, 2025 | 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 19, 2024 | Jul 20, 2025 | 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 |
| 11.003.079 | Invasive Prenatal (Fetal) Diagnostic Testing | Sep 13, 2024 | Sep 20, 2025 | Invasive prenatal (fetal) diagnostic testing may be used to identify pathogenic genetic alterations in... | View |
| 11.003.081 | Genetic Testing For Macular Degeneration | Apr 22, 2025 | Apr 20, 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 12, 2025 | Mar 20, 2026 | Facioscapulohumeral muscular dystrophy (fshd) is an autosomal dominant disease that typically presents before... | View |
| 11.003.083 | Genetic Testing For Charge Syndrome | Mar 12, 2025 | Mar 20, 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 12, 2025 | Mar 20, 2026 | Dilated cardiomyopathy (dcm) is characterized by progressive left ventricular enlargement and systolic... | View |
| 11.003.085 | Genetic Testing For Limb-Girdle Muscular Dystrophies | Jun 18, 2024 | Policy Archived | ... | View |
| 11.003.086 | Kif6 Genotyping For Predicting Cardiovascular Risk | Aug 20, 2021 | Policy Archived | Genetic testing to determine kinesin-like protein 6 (kif6) trp719arg variant status is being evaluated as a... | View |
| 11.003.087 | Molecular Testing In The Management Of Pulmonary Nodules | Jun 18, 2024 | Jun 20, 2025 | Plasma-based proteomic screening and gene expression profiling of bronchial brushing are molecular tests... | View |
