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
11.003.076 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 Jun 2026 National guidelines recommend that all pregnant individuals be offered screening for fetal chromosomal... View
11.003.079 Invasive Prenatal (Fetal) Diagnostic Testing Sep 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 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 2026 Facioscapulohumeral muscular dystrophy (fshd) is an autosomal dominant disease that typically presents before... View
11.003.083 Genetic Testing For Charge Syndrome Mar 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 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 2024 ... View
11.003.086 Kif6 Genotyping For Predicting Cardiovascular Risk Aug 2021 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 2026 Plasma-based proteomic screening and gene expression profiling of bronchial brushing are molecular tests... View
11.003.088 Molecular Testing For Chronic Heart Failure And Heart Transplant Jun 2021 Clinical assessment and noninvasive imaging of chronic heart failure can be limited in accurately diagnosing... View
11.003.089 Circulating Tumor Dna And Circulating Tumor Cells For Cancer Management (Liquid Biopsy) Sep 2024 Circulating tumor dna (ctdna) and circulating tumor cells (ctcs) in peripheral blood, referred to as... View
11.003.090 Gene Expression Profiling For Uveal Melanoma Mar 2025 Uveal melanoma is associated with a high rate of metastatic disease, and survival after the development of... View
11.003.092 Proteogenomic Testing For Patients With Cancer Jul 2025 Proteogenomics refers to the integration of genomic information with proteomic and transcriptomic information... View
11.003.093 Genetic Testing For Mitochondrial Disorders Oct 2025 Mitochondrial diseases are multisystem diseases that arise from dysfunction in the mitochondrial protein... View
11.003.094 Serum Biomarket Panel Testing For Systemic Lupus Erythematosus And Other Connective Tissue Deseases Jul 2025 Systemic lupus erythematosus (sle) is an autoimmune connective tissue disease (ctd) that can be difficult to... View
11.003.095 Genotype-Guided Tamoxifen Treatment Sep 2024 Tamoxifen is prescribed as a component of adjuvant endocrine therapy to prevent endocrine receptor-positive... View
11.003.096 Miscellaneous Genetic And Molecular Diagnostic Tests Aug 2024 There are numerous commercially available genetic and molecular diagnostic, prognostic, and therapeutic tests... View
11.003.097 Gene Expression Profiling For Cutaneous Melanoma Jun 2026 Laboratory tests have been developed that detect the expression of different genes in pigmented lesions or... View