Molecular Diagnostic Testing

Indicates Non-Covered Service

Molecular Diagnostic Testing

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Genetic Testing for Inherited Diseases

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Genotype Testing for Individual Genetic Polymorphisms to Determine Drug-Metabolizer Status

MolDX: AlloSure® Donor-Derived Cell-Free DNA Test

MolDX: APC & MUTYH Gene Testing

MolDX:

BDX-XL2

MolDX:

Biomarkers In Cardiovascular

Risk

Assessment

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-Aetna-

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Inherited Peripheral Neuropathies Genetic Testing

-UHC-

MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease

MolDX: ProMark Risk Score

Mutation Analysis in Myeloproliferative Neoplasms

Pharmaco-genetic Testing for Non-Cancer Indications

-Cigna-

Rett Syndrome

Genetic Testing

Alpha- & Beta-Thalassemia - Genetic Testing

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Indicates Non-Covered Service

Concurrent DNA & RNA Genetic Testing

-Humana-

Gene Expression Profile Testing & Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer

Gene Expression Profiling for Prostate Cancer

-Humana-

MolDX: Circulating Tumor Cell Marker Assays

MolDX: Corus CAD Assay

MolDx: Testing for Lyme Disease & Other Vector Borne Illness

-Humana-

MolDX: Prometheus IBD sgi Diagnostic Policy

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Adolescent Idiopathic Scoliosis - Genetic Testing

Alzheimer’s Disease - Genetic Testing

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Circulating Tumor DNA Panel Testing (Liquid Biopsy)

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Gene Expression Profile Tests for Multiple Myeloma

Gene Expression Profiling and Genomic Biomarker Tests for Prostate Cancer

Gene Expression Profiling for Bladder Cancer

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Gene Expression Profiling for Cancers of Unknown Primary Site

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Gene Expression Profiling for Colorectal Cancer

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Gene Expression Profiling for Idiopathic Pulmonary Fibrosis

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

Gene Expression Profiling of Melanomas

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Genetic Testing for Frontotemporal Dementia (FTD)

-Anthem-

Genetic Testing for Macular Degeneration

-Anthem-

Genetic Testing for Inherited Peripheral Neuropathies

-Anthem-

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Genetic Testing for Statin-Induced Myopathy

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Genetic Testing to Confirm the Identity of Laboratory Specimens

-Anthem-

Lactase Insufficiency - Genetic Testing

Metagenomic Sequencing for Infectious Disease in the Outpatient Setting

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

Topographic Genotyping

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TruGraf Blood Gene Expression Test for Transplant Monitoring

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-Anthem-

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