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Medical Policy

Laboratory Section

Policy Name Date Modified
Allergy and Sensitivity Tests of Uncertain Efficacy 08/01/2021
Analysis of Proteomic and Metabolomic Patterns for Cancer Detection, Risk, Prognosis, or Treatment Selection 07/01/2021
Biochemical and Cellular Markers of Alzheimer's Disease 08/01/2021
Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover 09/01/2020

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

04/01/2021
COVID-19 Testing 07/01/2021

Drug Testing for Substance Use and Pain Management

01/01/2021
In Vitro Chemoresistance and Chemosensitivity Assays 07/01/2021
Laboratory and Genetic Testing for Use of 5-Flurouracil  (5-FU) in Patients with Cancer 03/01/2021
Laboratory Tests for Heart, Kidney, and Lung Transplant Rejection 09/01/2021
Maternal Serum Analysis for Risk of Preterm Birth 04/01/2021
Measurement of Lipoprotein-Associated Phospholipase A2 Lp-PLA2) in the Assessment of Cardiovascular Risk 09/01/2021

Measurement of Serum Antibodies to Selected Biologic Agents

09/01/2021
Molecular Testing in the Management of Pulmonary Nodules 11/01/2020
Multi-biomarker Disease Activity Blood Test for Rheumatoid Arthritis 08/01/2021
Multianalyte Assays with Algorithmic Analyses for the Evaluation and Monitoring of Patients with Chronic Liver Disease 09/01/2021
Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer 03/01/2021
Placental Rapid Immunoassay for Detection of Fetal Membrane Rupture 03/01/2021
Protein Biomarkers and Multi-analyte Biomarker Tests for Screening, Detection, and/or Management of Prostate Cancer 01/01/2021
Salivary Hormone Testing for Aging and Menopause 05/01/2021
Serum Holotranscobalamin as a Marker of Vitamin B12 (i.e., Cobalamin) Status 05/01/2021
Urinary Biomarkers for Cancer Screening, Diagnosis, and Surveillance 10/01/2020

Vitamin D Testing

02/01/2021