Concert Genetic Oncology: Cytogenetic Testing

This policy covers tumor‑based cytogenetic and molecular testing (e.g., FISH, PCR, NGS, IHC) to classify and diagnose solid tumors and hematologic malignancies and to identify somatic driver alterations to guide targeted therapy, prognosis, and treatment response (examples: ALK/ROS1/RET, ERBB2/HER2, NTRK, PD‑L1, FOLR1, PML/RARA, CLL and multiple myeloma FISH panels). Major limits/requirements: ctDNA/CTC liquid biopsy is excluded (covered under other policies), bladder FISH/tumor‑marker testing has specific indication, validation and frequency caps (not for routine hematuria screening and UroVysion is the FDA‑approved assay), CLL panels are limited to specified abnormalities and initial workup, and HER2/other ISH/IHC testing is restricted to listed clinical indications.

"Cytogenetic/molecular analysis to classify the type of solid tumor or hematologic malignancy."