BlueCross BlueShield of Tennessee Medical Policy Manual

Genetics

• Breast Cancer Gene Expression Assays

• Chromosomal Microarray Analysis for Evaluation of Pregnancy Loss

• 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 (Human Leukocyte Antigen) Testing for Celiac Disease

• Genetic Testing for CHARGE Syndrome

• Genetic Testing for CHEK2 Mutations for Breast Cancer

• Genetic Testing for Epilepsy

• Genetic Testing for Facioscapulohumeral Muscular Dystrophy

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

• Genetic Testing for Macular Degeneration

• Genetic Testing for Mental Health Conditions

• Genetic Testing for Mitochondrial Disorders

• Genetic Testing for Warfarin Dose

• Genotyping for 9p21 Single Nucleotide Polymorphisms to Predict Risk of Cardiovascular Disease or Aneurysm

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

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

• Molecular Markers in Fine Needle Aspirates of the Thyroid

• Non-invasive Prenatal Testing Using Cell-free Fetal DNA (cffDNA)

• Nonfamilial Genetic Testing for Breast Cancer Risk Assessment

• Novel Biomarkers for the Diagnosis and Management of Prostate Cancer

• Proteomic Testing in Non-Small Cell Lung Cancer

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