| Policy Name |
Policy ID Number |
Date Modified |
| Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening |
GT12 |
01/01/2024 |
| Apolipoprotein E for Risk Assessment and Management of Cardiovascular Disease |
GT05 |
03/01/2024 |
Assays of Genetic Expression
in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer |
GT42 |
03/01/2024 |
| BRAF Genetic Testing To Select Melanoma
or Glioma Patients for Targeted Therapy |
GT41 |
10/01/2023 |
| Chromosomal Microarray Analysis (CMA) or Copy Number Analysis for the Genetic Evaluation of Patients with Developmental
Delay, Intellectual Disability, Autism Spectrum Disorder, or Congenital Anomalies |
GT58 |
08/01/2023 |
| ClonoSEQ® Testing for the Assessment of Measurable Residual Disease (MRD) |
GT88 |
04/01/2023 |
Cytochrome p450 and VKORC1 Genotyping for Treatment Selection and Dosing |
GT10 |
01/01/2024 |
| Diagnostic Genetic Testing for α-Thalassemia |
GT52 |
04/01/2024 |
| Diagnostic Genetic Testing for FMR1 and AFF2 Variants (including Fragile X and Fragile XE Syndromes) |
GT43 |
04/01/2024 |
| Evaluating the Utility of Genetic Panels |
GT64 |
04/01/2024 |
| Expanded Molecular Testing of Cancers to Select Targeted Therapies |
GT83 |
04/01/2024 |
| Fetal RHD Genotyping using Maternal Plasma |
GT74 |
01/01/2024 |
| Gene Expression Profiling for Melanoma |
GT29 |
08/01/2023 |
| Gene Expression-Based Assays for Cancers of Unknown
Primary |
GT15 |
04/01/2023 |
| Gene-Based Tests for Screening, Detection, and Management of Prostate or Bladder Cancer |
GT17 |
01/01/2024 |
| Genetic and Molecular Diagnostic
Testing |
GT20 |
01/01/2024 |
| Genetic Testing for Alpha-1 Antitrypsin Deficiency |
GT61 |
08/01/2023 |
| Genetic Testing for Alzheimer's Disease |
GT01 |
01/01/2024 |
| Genetic Testing for Biallelic RPE65 Variant-Associated Retinal Dystrophy |
GT21 |
01/01/2024 |
| Genetic Testing for CADASIL Syndrome |
GT51 |
01/01/2024 |
| Genetic Testing for Cutaneous Malignant Melanoma |
GT08 |
04/01/2024 |
| Genetic Testing for Diagnosis and Management of Behavioral Health Conditions |
GT53 |
01/01/2024 |
| Genetic Testing for Duchenne and Becker Muscular Dystrophy |
GT69 |
03/01/2024 |
Genetic Testing for Epilepsy |
GT80 |
01/01/2024 |
| Genetic Testing for Familial Hypercholesterolemia |
GT11 |
02/01/2024 |
Genetic Testing for Hereditary Breast and
Ovarian Cancer and Li-Fraumeni Syndrome |
GT02 |
04/01/2024 |
| Genetic Testing for Heritable Disorders of Connective Tissue |
GT77 |
01/01/2024 |
| Genetic Testing for Lactase Insufficiency |
GT67 |
03/01/2024 |
| Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes |
GT06 |
01/01/2024 |
| Genetic Testing for Macular Degeneration |
GT75 |
01/01/2024 |
| Genetic Testing for Methionine Metabolism Enzymes, including MTHFR |
GT65 |
02/01/2024 |
Genetic Testing for Myeloid Neoplasms and Leukemia |
GT59 |
01/01/2024 |
| Genetic Testing for Neurofibromatosis Type 1 or 2 |
GT84 |
01/01/2024 |
| Genetic Testing for Primary Mitochondrial Disorders |
GT54 |
01/01/2024 |
| Genetic Testing for PTEN Hamartoma Tumor Syndrome |
GT63 |
08/01/2023 |
Genetic Testing for Rett Syndrome |
GT68 |
01/01/2024 |
| Genetic Testing for Statin-Induced Myopathy |
GT50 |
03/01/2024 |
| Genetic Testing for the Diagnosis of Inherited Peripheral Neurophathies |
GT66 |
03/01/2024 |
| Genetic Testing for the Evaluation of Products of Conception and Pregnancy Loss |
GT79 |
07/01/2023 |
Genotyping for 9p21 Single Nucleotide Variants to Predict Risk of Cardiovascular Disease or Aneurysm |
GT62 |
04/01/2024 |
Identification of Microorganisms Using Nucleic Acid Probes |
GT85 |
04/01/2024 |
| IDH1 and IDH2 Genetic Testing for Conditions Other Than Myeloid Neoplasms or Leukemia |
GT19 |
04/01/2024 |
| Invasive Prenatal Fetal Diagnostic Testing Using Chromosomal Abnormalities |
GT78 |
01/01/2024 |
| KRAS, NRAS,
and BRAF Variant Analysis and MicroRNA Expression Testing for Colorectal Cancer |
GT13 |
03/01/2024 |
| Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification |
GT70 |
03/01/2024 |
| Molecular Testing for Interstitial Lung Disease |
GT55 |
02/01/2024 |
Noninvasive Prenatal Testing to Determine Fetal Aneuploidies, Microdeletions, Single-Gene Disorders, and Twin Zygosity |
GT44 |
04/01/2024 |
| Topographic Genotyping to Classify Cancer Risk |
GT16 |
07/01/2023 |
| Preimplantation
Genetic Testing of Embryos |
GT18 |
07/01/2023 |
| Reproductive Carrier Screening for Genetic Diseases |
GT81 |
01/01/2024 |
| Serologic Genetic and Molecular Screening for Colorectal Cancer |
GT86 |
08/01/2023 |
| Single-nucleotide Variants (SNVs) to Predict Risk of NonFamilial Breast Cancer |
GT23 |
08/01/2023 |
| Targeted Genetic Testing for Selection of Therapy for Non-Small Cell Lung
Cancer (NSCLC) |
GT56 |
02/01/2024 |
Whole Exome and Whole Genome Sequencing |
GT76 |
03/01/2024 |
