BlueCross BlueShield of Tennessee Medical Policy Manual

Hematology/Oncology

• Adoptive Immunotherapy

• Breast Cancer Gene Expression Assays

• Cryosurgical Ablation of Solid Tumors

• Donor Lymphocyte Infusion for Hematologic Malignancies Treated with an Allogeneic Hematopoietic Stem Cell Transplant

• Electrical Impedance Scanning of the Breast

• Electronic Brachytherapy for Non-Melanoma Skin Cancer

• Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies

• Genetic Testing for CHEK2 Mutations for Breast Cancer

• Hematopoietic Progenitor Cell (HPC) Boost

• Hematopoietic Stem Cell Transplantation for Central Nervous System Embryonal and Ependymoma Tumors

• Hematopoietic Stem-Cell Transplantation for Malignant Astrocytomas and Gliomas

• Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults

• Hemodialysis in the Home

• Intensity-Modulated Radiotherapy (IMRT) of the Breast and Lung

• Intraoperative Radiation Therapy (IORT)

• Lymphatic Physiologic Microsurgery for Breast Cancer-Related Lymphedema

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

• Microwave Ablation for Oncologic Tumors

• Molecular Markers in Fine Needle Aspirates of the Thyroid

• MRI-Guided Focused Ultrasound (MRgFUS)

• Nonfamilial Genetic Testing for Breast Cancer Risk Assessment

• Novel Biomarkers for the Diagnosis and Management of Prostate Cancer

• Ovarian Cancer Tumor Markers

• Photodynamic Therapy (PDT) for the Treatment of Certain Cancers

• Plasma Exchange

• Proteomic Testing in Non-Small Cell Lung Cancer

• Proteomics-based Testing for the Evaluation of Ovarian (Adnexal) Masses

• Proton Beam Therapy

• Radioembolization for Primary Tumors and Metastatic Tumors to the Liver

• Radiotherapy for Prostate Cancer

• Saturation Biopsy for Diagnosis and Staging of Prostate Cancer

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

• Transcatheter Hepatic Arterial Chemoembolization

This document has been classified as public information.