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Medical Policy

Laboratory Section

Policy Name Date Modified
Allergy Tests of Uncertain Efficacy 08/01/2018
Analysis of Proteomic and Metabolomic Patterns for Early Detection or Assessing Risk of Cancer 02/01/2019
Biochemical Markers of Alzheimer's Disease 08/01/2018
Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover 08/01/2018

Circulating Tumor DNA and Circulating Tumor Cells for Management (Liquid Biopsy) of Solid Tumor Cancers

In Vitro Chemoresistance and Chemosensitivity Assays 01/01/2019
Laboratory and Genetic Testing for Use of 5-Flurouracil  (5-FU) in Patients with Cancer 02/01/2019
Laboratory and Genetic Testing for use of Thiopurines 01/01/2019
Laboratory Tests for Heart Transplant Rejection 07/01/2018
Measurement of Lipoprotein-Associated Phospholipase A2 Lp-PLA2) in the Assessment of Cardiovascular Risk 06/01/2018
Measurement of Serum Antibodies to Infliximab and Adalimumab 05/01/2018
Molecular Testing in the Management of Pulmonary Nodules 01/01/2019
Multianalyte Assays with Algorithmic Analyses for the Evaluation and Monitoring of Patients with Chronic Liver Disease 01/01/2019
Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer 03/01/2019
Placental Rapid Immunoassay for Detection of Fetal Membrane Rupture 02/01/2018
Protein Biomarkers for Screening, Detection, and/or Management of Prostate Cancer 01/01/2019
Salivary Hormone Testing for Aging and Menopause 03/01/2019
Serum Holotranscobalamin as a Marker of Vitamin B12 (i.e., Cobalamin) Status 05/01/2018
Urinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance 10/01/2018

Urine Drug Testing for Substance Use and Pain Management

Vectra DA Blood Test for Rheumatoid Arthritis 08/01/2018

Vitamin D Testing