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
11.003.029 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 2025 Hereditary breast and ovarian cancer syndrome describes the familial cancer syndromes related to variants in... View
11.003.031 Genetic Testing For Hereditary Hemochromatosis Jun 2025 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
11.003.033 Análisis de los patrones proteómicos séricos para identificar el cáncer de ovari May 2016 ... View
11.003.034 Genetic And Protein Biomarkers For The Diagnosis And Cancer Risk Assessment Of Prostate Cancer Dec 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 2024 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 2025 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 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 2019 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 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 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 2026 Genetic testing is available for individuals suspected of having cardiac ion channelopathies, including long... View
11.003.046 Genetic Testing For Fmr1 Variants (Including Fragile X Syndrome) Feb 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 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 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 Feb 2026 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 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 Mar 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 2025 To determine which patients need thyroid resection, many physicians will perform a cytologic examination of... View