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
11.003.053 Whole Exome And Whole Genome Sequencing For Diagnosis Of Genetic Disorders Feb 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 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 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 2026 ... View
11.003.060 Genetic Testing For Flt3, Npm1, And Cebpa Variants In Cytogenetically Normal Acute Myeloid Leukemia Feb 2026 Treatment of acute myeloid leukemia (aml) is based on risk stratification, primarily related to age and tumor... View
11.003.061 Genotipado de Nucleótido único 9p21-polimorfismos de Predecir el Riesgo Oct 2016 ... View
11.003.062 General Approach To Genetic Testing Jan 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 Nov 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 Feb 2026 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 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 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 2026 The inherited peripheral neuropathies are a heterogeneous group of diseases that may be inherited in an... View
11.003.069 Analysis Of Mgmt Promoter Methylation In Malignant Gliomas Jun 2019 Testing for o6-methylguanine-dna methyltransferase (mgmt) gene promoter methylation has been proposed as a... View
11.003.070 Preimplantation Genetic Testing Sep 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 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 2025 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 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 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 2016 ... View
11.003.078 Noninvasive Prenatal Screening For Fetal Aneuploidies And Microdeletions Using Cell-Free Fetal Dna Apr 2026 ... View