Concert Genetic Oncology: Algorithmic Testing

This policy covers algorithmic and genomic oncology testing—including proteogenomic assays, polygenic risk scores, prognostic/recurrence scoring and named tests (e.g., Oncotype DX, MammaPrint, Prosigna, Decipher, Prolaris, Immunoscore)—to aid diagnosis, prognosis and treatment decision-making across multiple cancers (notably breast including DCIS, colorectal, prostate, thyroid, melanoma and others). Coverage is limited to the specific tests and ICD-10-CM indications listed; assays or uses labeled as “emerging evidence” are considered investigational and not covered, and any test addressed by a more specific policy is governed by that policy’s criteria.

"Proteogenomic testing (combined DNA with RNA and/or protein analysis) for diagnostic and prognostic evaluation in various cancers and to identify potential treatment options and possible treatment ..."

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