JAK2 testing may be considered medically necessary in the diagnosis of individuals presenting with clinical, laboratory, or pathologic findings suggesting polycythemia vera, essential thrombocythemia (ET), or primary myelofibrosis (PMF). Based on criteria from the World Health Organization and the International Consensus Classification for diagnosis of PV, documentation of a serum erythropoietin level below the reference range for normal is recommended before JAK2 testing (See Policy Guidelines).
MPL and CALR testing may be considered medically necessary in the diagnosis of individuals presenting with clinical, laboratory, or pathologic findings suggesting ET or PMF.
JAK2, MPL, and CALR testing is considered investigational in all other circumstances including, but not limited to, the following situations:
Diagnosis of nonclassic forms of myeloproliferative neoplasms (MPNs)
Molecular phenotyping of individuals with MPNs
Monitoring, management, or selecting treatment in individuals with MPNs.
