BlueCross BlueShield of Tennessee Medical Policy Manual

Genetic Disease

• Agalsidase Beta

• Alglucosidase Alfa

• Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening

• Array Comparative Genomic Hybridization (aCGH) for the Genetic Evaluation of Individuals with Developmental Delay/Mental Retardation

• Cytochrome p450 Genotyping

• First-Trimester Detection of Down Syndrome Using Fetal Ultrasound Markers Combined with Maternal Serum Assessment

• Gene Expression Profiling Assays as a Technique to Determine Prognosis for Managing Breast Cancer Treatment

• Gene Expression Testing for Coronary Artery Disease

• Gene-based Tests for Screening, Detection, and/or Management of Prostate Cancer

• Genetic Testing for Alzheimer's Disease

• Genetic Testing for BRCA1, BRCA2 or CHEK2 for Breast or Ovarian Cancer

• Genetic Testing for Congenital Cardiac Channelopathies

• Genetic Testing for Cutaneous Malignant Melanoma

• Genetic Testing for Cystic Fibrosis

• Genetic Testing for Helicobacter pylori Treatment

• Genetic Testing for HER-2

• Genetic Testing for Inherited Susceptibility to Colorectal Cancer

• Genetic Testing for Medullary Thyroid Carcinoma

• Genetic Testing for Tamoxifen Treatment

• Genetic Testing for Warfarin Dose

• Genotyping for Chronic Hepatitis C

• KIF6 Genotyping for Predicting Cardiovascular Risk and/or Effectiveness of Statin Therapy

• Laronidase

• Microarray-based Gene Expression Testing for Cancers of Unknown Primary

• Multi-gene Expression Assay for Predicting Recurrence in Colon Cancer

• Non-BRCA Breast Cancer Risk Assessment

• Use of Common Genetic Variants to Predict Risk of Nonfamilial Breast Cancer

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