BlueCross BlueShield of Tennessee Medical Policy Manual

Pathology

• Breast Cancer Gene Expression Assays

• Chromosomal Microarray Analysis for Evaluation of Pregnancy Loss

• Circulating Tumor DNA (Liquid Biopsy)

• Cytochrome p450 Genotyping

• Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies

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

• Gene Expression Profile Analysis for Prostate Cancer Management

• Genetic Testing for CHARGE Syndrome

• Genetic Testing for CHEK2 Mutations for Breast Cancer

• Genetic Testing for Facioscapulohumeral Muscular Dystrophy

• Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment

• Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Connective Tissue Disorders

• Genetic Testing for Mental Health Conditions

• Genetic Testing for Mitochondrial Disorders

• Genetic Testing for Warfarin Dose

• In Vitro Particle Size Measurement for Screening Hypersensitivity Reactions to Foods and Chemicals

• Leukocyte Histamine Release Test (LHRT)

• Molecular Markers in Fine Needle Aspirates of the Thyroid

• Multi-biomarker Testing for Rheumatoid Arthritis

• Next-Generation Sequencing for the Assessment of Measurable Residual Disease

• Nonfamilial Genetic Testing for Breast Cancer Risk Assessment

• Novel Biomarkers for the Diagnosis and Management of Prostate Cancer

• Ovarian Cancer Tumor Markers

• Pharmacogenetic Testing for Pain Management

• Prostate Specific Antigen (PSA)

• Protein Profiling Assays for Breast Cancer Prognosis

• Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases

• Urinary Metabolite Tests for Adherence to Direct-Acting Antiviral Medications for Hepatitis C

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