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Indicates Non-Covered Service

Acute Myeloid Leukemia Genetic Testing

ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP)

AlloSure Donor-Derived Cell-Free DNA Test

Allergy Testing

-Aetna-

Testing for Alpha-1 Antitrypsin Deficiency

APC & MUTYH Gene Testing

Atherosclerotic Cardiovascular Disease Risk Assessment

Alzheimer’s Disease - Genetic Testing

Testing for Biochemical Markers for Alzheimer’s Disease

-Anthem-

BCR-ABL1 Testing in Chronic Myelogenous Leukemia & Acute Lymphoblastic Leukemia

Biomarkers In Cardiovascular

Risk

Assessment

Biomarkers for Oncology:

Acute Lymphoid Leukemia (ALL)

Biomarkers for Oncology:

Brain

Biomarkers for Oncology:

Chronic Lymphoid Leukemia (CLL)

Biomarkers for Oncology: Colorectal Cancer

Biomarkers for Oncology:

Hairy Cell Leukemia

Biomarkers for Oncology: Melanoma

Biomarker Testing for Multiple Sclerosis & Related Neurologic Diseases

Biomarkers for Oncology:

Non-Small Cell Lung Cancer (NSCLC)

Biomarkers for Oncology:

Uterus/Ovary/Fallopian Tube/Peritoneum

Biomarkers for Oncology:

Urinary Tract

BRAF Mutation Analysis

Brain

Natriuretic Peptide

(BNP)

Breast Cancer Index℠ Genetic Assay

BRCA1 & BRCA2 Genetic Testing

Breast Cancer Assay: Prosigna

Breast Cancer Index Genetic Assay

B-Type Natriuretic Peptide (BNP)

Bladder Tumor Markers

CADASIL Syndrome Genetic Testing

Cardiac Ion Channel Genetic Testing

Genetic Testing for Diagnosis & Management of Hereditary Cardiomyopathies (including ARVD/C)

Cardiovascular Disease (CVD) Risk Testing

-Humana-

Carrier Screening in Pregnancy

Carrier Testing for Genetic Diseases

-UHC-

Celiac Diease Laboratory Testing

Cell-free Fetal DNA Testing

-UHC-

Chromosomal Microarray

-UHC-

Chromosome 1p/19q Deletion Analysis

Circulating Tumor Cell Testing

Colorectal Cancer: Biomarkers for Oncology

Analysis of Human DNA for Colorectal Cancer Screening

ConfirmMDx Epigenetic Molecular Assay

Controlled Substance Monitoring & Drugs of Abuse Testing

Comparative Genomic Hybridization (CGH) - Chromosomal Microarray Analysis (CMA) for Selected Hereditary Conditions

COVID-19

In Vitro Diagnostic Testing

-Aetna-

Creatine Kinase (CK), (CPK)

Cutaneous Malignant Melanoma - Genetic Testing

CYP2C19, CYP2D6, CYP2C9, & VKORC1 Genetic Testing

Cytogenetic Studies

Cystatin C Measurement

Cystic Fibrosis - Genetic Testing

DecisionDx-UM (Uveal Melanoma)

Decipher® Prostate Cancer Classifier Assay

DNA Analysis of Stool to Screen for Colorectal Cancer

Drug

Testing

-Aetna-

Drug Testing in Pain Management & Substance Use Disorder Treatment

Outpatient Testing for Drugs of Abuse

Duchenne, Becker, Facioscapulohu-meral, & Limb-Girdle Muscular Dystrophies-

Geneic Testing

Genetic Testing for Ehlers-Danlos Syndrome

EndoPredict Breast Cancer Gene Expression Test

Erythrocyte Sedimentation

Rate

Genetic Testing for Endocrine Gland Cancer Susceptibility

Epilepsy -

Genetic Testing

Genetic Testing for Fanconi Anemia

Fecal Calprotectin Testing

-UHC-

Fine Needle Aspirates of the Thyroid - Molecular Markers

Flow Cytometry

-Aetna-

Flow Cytometry

for Cell Cycle or DNA Analysis

Flow Cytometry

for Cell Surface, Cytoplasmic, or Nuclear Marker

Folate Testing

Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)

Molecular Gastrointestinal Pathogen Panel (GIPP) Testing for Infectious Diarrhea in the Outpatient Setting

Gene Expression Profiling for Colorectal Cancer

Genetic Testing for Breast, Ovarian and Pancreatic Cancer Susceptibility

-Humana-

Genetic Testing for Cardiac Disease

-UHC-

Genetic Testing for Catecholaminergic Polymorphic Ventricular Tachycardia

Genetic Testing for Diagnosis and Monitoring of Cancer

-Humana-

Genetic Testing For Neuro-degenerative

Disorders

Genitourinary Conditions

Testing

Germline Mutations of the RET Proto-Oncogene - Genetic Testing

Gliomas - Molecular Analysis

HbA1c

Heavy Metal Testing

Helicobacter Pylori Infection Testing

Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors & Ependymoma

Hepatic (Liver) Function Panel

Hepatitis Screening

-UHC-

Hepatitis B

Surface

Antibody

Hepatitis B

Surface

Antigen

Hereditary Hearing Loss - Genetic Testing

Hereditary Hemochromatosis - Genetic Testing

Hereditary Pancreatitis - Genetic Testing

Heterozygous Familial Hypercholester-olemia - Genetic Testing

High Sensitivity C-Reactive Protein (hsCRP)

Testing of Homocysteine Metabolism-Related Conditions

Human Papillomavirus (HPV) Testing

Helicobacter Pylori Serology Testing

-Cigna-

Testing for the Diagnosis & Management of Inflammatory Bowel Disease

Diagnostic Testing of Influenza

Inherited Cardiomy-opathies & Channel-opathies - Genetic Testing

Inherited Peripheral Neuropathies Genetic Testing

Ionized

Calcium

KRAS, NRAS, & BRAF Variant Analysis in Metastatic Colorectal Cancer

-FloridaBlue-

K-ras Testing Required before Epidermal Growth Factor Receptor Antibody Use in Colorectal Cancer

Analysis of KRAS Status

Laboratory Testing as an Aid in the Diagnosis of Heart Transplant Rejection

Lactase Insufficiency - Genetic Testing

Acute Lymphoid Leukemia (ALL): Biomarkers for Oncology:

Chronic Lymphoid Leukemia (CLL): Biomarkers for Oncology

Hairy Cell Leukemia: Biomarkers for Oncology

Li-Fraumeni Syndrome - Genetic Testing

-FloridaBlue-

Marfan Syndrome Testing

Heavy Metal Testing

MGMT Promoter Methylation Analysis

Mitochondrial Disorders Genetic Testing

Molecular Diagnostic Testing

-Medicare-

Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions

Selected Tests for Myopathy

-Aetna-

Neurodegener-ative Disorders -Genetic Testing

Neurofibroma-tosis & Related Disorders - Genetic Testing

Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA

-FloridaBlue-

This sub-section has no entries at this time.

Parathormone (Parathyroid Hormone)

Pathology & Laboratory: Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing

Pathogen Panel Testing

Pharmaco-genetic & Pharmaco-dynamic Testing

-Aetna-

Pharmacogenomics Testing for FDA Known Gene-Drug Interactions

-Cigna-

-Medicare-

Preimplantation Genetic Diagnosis Testing

-UHC-

Prostate Cancer Screening (Commercial)

Medicare)

Prenatal Genetic and Chromosomal Metabolic Testing

Respiratory Viral Panel Testing in the Outpatient Setting

Rett Syndrome

Genetic Testing

Laboratory Testing for Rheumatic Diseases

Sedimentation Rate, Erythrocyte

Measurement of Serum 1,25-dihydroxy-vitamin D

Serum Iron Testing

-Anthem-

Serum

Phosphorus

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Serologic (Antibody) Testing

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Viral (Antigen or Molecular) Testing

Skin Nerve Fiber Density Testing

-Humana-

Susceptibility Studies

Sweat

Test

Syphilis

Test

Saliva-based Testing to Determine Drug-Metabolizer Status

-Anthem-

Targeted Phototherapy & Psoralen with Ultraviolet A for Vitiligo

Alpha- & Beta-Thalassemia - Genetic Testing

Metabolite Markers of Thiopurines Testing

Thyroid Testing

-Anthem-

Total

Calcium

Troponin

Tropism Testing for

HIV Management

Umbilical Cord Blood Testing & Storage

Urinalysis

Urinary Tract: Biomarkers for Oncology

Urinary Tumor Markers for Bladder Cancer

Uterus/Ovary/Fallopian Tube/Peritoneum: Biomarkers for Oncology

Diagnostic Testing for the Evaluation of Vaginitis

Laboratory Evaluation

Vitamin B 12

-Anthem-

Vitamin D Assay Testing

-Cigna-

Vitamin D 25 Hydroxy, includes Fraction(s), if Performed

-Humana-

This sub-section has no entries at this time.

Indicates Non-Covered Service

Adolescent Idiopathic Scoliosis - Genetic Testing

Advanced Lipoprotein Testing

Alzheimer’s Disease - Genetic Testing

-Anthem-

Analysis of Proteomic Patterns

-Anthem-

Bronchial Gene Expression Classification for the Diagnostic Evaluation of Lung Cancer

Cell-free DNA Testing to Aid in the Monitoring of Kidney Transplants for Rejection

Chemoresistance & Chemosensitivity Assays

-FloridaBlue-

-Anthem-

Circulating Tumor DNA Panel Testing (Liquid Biopsy)

-Anthem-

Detection of Circulating Tumor Cells in the Blood as a Prognostic Factor for Cancer

Fecal Analysis in the Diagnosis of Intestinal Disorders

Gene Expression Profile Tests for Multiple Myeloma

-Anthem-

Gene Expression Profiling and Genomic Biomarker Tests for Prostate Cancer

Gene Expression Profiling for Bladder Cancer

-Anthem-

Gene Expression Profiling for Cancers of Unknown Primary Site

-Anthem-

-FloridaBlue-

Gene Expression Profiling for Colorectal Cancer

-Anthem-

Gene Expression Profiling for Idiopathic Pulmonary Fibrosis

Gene Expression Profiling for Risk Stratification of Inflammatory Bowel Disease (IBD) Severity

Gene Expression Profiling of Melanomas

-Anthem-

Genetic Testing for Frontotemporal Dementia (FTD)

-Anthem-

Genetic Testing for Macular Degeneration

-Anthem-

Genetic Testing for Inherited Peripheral Neuropathies

-Anthem-

Genetic Testing for Statin-Induced Myopathy

-Anthem-

Genetic Testing to Confirm the Identity of Laboratory Specimens

Hematopoietic Cell Transplantation for Breast Cancer

-Anthem-

Immune Biomarker Tests for Cancer

-Anthem-

Immune Cell Function Assay

-Anthem-

Intracellular Micronutrient Analysis

-FloridaBlue-

In Vitro Chemosensitivity Assays & In Vitro Chemoresistance Assays

-Anthem-

Machine Learning Derived Probability Score for Rapid Kidney Function Decline

-Anthem-

Metagenomic Sequencing for Infectious Disease in the Outpatient Setting

-Anthem-

Measurement of Apolipoprotein B (apo B) & Apolipoprotein E (apo E) in Risk Assessment & Management of Cardiovascular Disease

Measurement of Serum Concentrations of Monoclonal Antibody Drugs and Antibodies to Monoclonal Antibody Drugs

-Anthem-

Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy

-Anthem-

Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, & Solid Pancreatic Lesions

-FloridaBlue-

Multianalyte Assays with Algorithmic Analyses for Cancer Indications

-Humana-

-FloridaBlue-

Multi-biomarker Disease Activity Blood Tests for Rheumatoid Arthritis

-Anthem-

Multiplex Autoantigen Microarray Testing for Systemic Lupus Erythematosus

-Anthem-

Paired DNA and Messenger RNA (mRNA) Genetic Testing to Detect, Diagnose and Manage Cancer

Pooled Antibiotic Sensitivity Testing

-Anthem-

Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease

Protein Biomarkers for the Screening, Detection & Management of Prostate Cancer

-Anthem-

Proteogenomic Testing for the Evaluation of Malignancies

Red Blood Cell Folic Acid Testing

-Anthem-

Rupture of Membranes Testing in Pregnancy

Screening for Vitamin D Deficiency in Average Risk Individuals

Selected Blood, Serum & Cellular Allergy & Toxicity Tests

SensiGene® Fetal RhD Genotyping Test

Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS)

-Anthem-

Serological Antibody Testing For Helicobacter Pylori

Serum Amylase Testing

-Anthem-

Serum Biomarker Tests for Multiple Sclerosis

Serum Biomarker Tests for Risk of Preeclampsia

Spectral Analysis of Prostate Tissue by Fluorescence Spectroscopy

Systems Pathology Testing for Prostate Cancer

Testing for Oral & Esophageal Cancer

-Anthem-

Topographic Genotyping

-Anthem-

TruGraf Blood Gene Expression Test for Transplant Monitoring

-Anthem-

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