MolDx

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Molecular Diagnostic Testing-Medicare

Indicates Non-Covered Service

4Kscore Test -

Medicare

Assays of Genetic Expression in Tumor Tissue as to Determine Prognosis in Patients with Breast Cancer

Concurrent DNA & RNA Genetic Testing

-Humana-

Gene Expression Profile Testing & Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer

Gene Expression Profiling for Prostate Cancer

-Humana-

Gene Mutation Testing for Solid Tumor Cancer Susceptibility & Management

Genetic Testing

Charge Syndrome

-Anthem-

-FloridaBlue-

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-FloridaBlue-

Genetic Testing for Inherited Diseases

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Genetic Testing for PTEN Hamartoma Tumor Syndrome

-Anthem-

Genotype Testing for Individual Genetic Polymorphisms to Determine Drug-Metabolizer Status

MolDX: AlloSure® Donor-Derived Cell-Free DNA Test

MolDX: APC & MUTYH Gene Testing

MolDX:

BDX-XL2

MolDX:

Biomarkers In Cardiovascular

Risk

Assessment

MolDX: BRCA1 & BRCA2 Genetic Testing

MolDX: Breast Cancer Assay: Prosigna

MolDX: Breast Cancer Index (BCI) Gene Expression Test

MolDX: Circulating Tumor Cell Marker Assays

MolDX: ConfirmMDx Epigenetic Molecular Assay

MolDX: Corus CAD Assay

MolDX: CYP2C19, CYP2D6, CYP2C9, & VKORC1 Genetic Testing

MolDX Decipher Biopsy Prostate Cancer Classifier Assay for Men with Very Low & Low Risk Disease

MolDX: Decipher® Prostate Cancer Classifier Assay

MolDX: DecisionDx-Melanoma

MolDX: DecisionDx-UM (Uveal Melanoma)

MolDX: EndoPredict Breast Cancer Gene Expression Test

MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test

MolDX: Foodborne Gastro-intestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)

MolDX: GeneSight ® Assay for Refractory Depression

MolDX: Genetic Testing for BCR-ABL Negative Myeloprolife-

rative Disease

MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, & MTHFR)

MolDX: Genetic Testing

for

Lynch Syndrome & Other Inherited Colon Cancer Syndromes

MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay

Molecular Analysis for Gliomas

MolDX: Guardant360 Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)

MolDX:

HLA-B15:02

Genetic

Testing

MolDX:

HLA-DQB1*06:02 Testing for Narcolepsy

MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer

MolDx: Testing for Lyme Disease & Other Vector Borne Illness

-Humana-

MolDX: MDS FISH

MolDX: MGMT Promoter Methylation Analysis

MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer

MolDX: Molecular RBC Phenotyping

MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels

MolDX: myPath Melanoma Assay

Genetic Testing for Neuromuscular Disorders

-UHC-

MolDX NRAS Genetic Testing

MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)

MolDX: Oncotype DX Breast Cancer for DCIS

MolDX: Oncotype DX Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer

MolDX: Percepta Bronchial Genomic Classifier

MolDX: Prolaris™ Prostate Cancer Genomic

Assay

MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease

MolDX: ProMark Risk Score

MolDX: Prometheus IBD sgi Diagnostic Policy

Mutation Analysis in Myelopro-liferative Neoplasms

Pharmaco-genetic Testing for Non-Cancer Indications

RET Proto-Oncogene Testing

-Aetna-

Genetic Testing for Heritable Cardiac Conditions

TP53 Mutations

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Tumor Genetic Markers

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-Cigna-

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