Concert Genetic Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies
AMBETTER-CG-Onc-Tumor-Hemat.-Malig.-2025.1
Molecular genomic testing of solid tumors and hematologic malignancies — including targeted and broad DNA/RNA panels, fusion testing, MSI/TMB assessment, tumor-only or tumor‑normal approaches, and select MRD assays — to inform diagnosis, prognosis, targeted therapy selection, and disease monitoring. Covered for patients with suspected or confirmed malignancies (ICD‑10 C00–D49 or Z85), including advanced cancers and specified tumor‑ or disease‑specific indications (e.g., colorectal, hematologic/myeloid cancers), but coverage is limited to the named assays and listed ICD‑10 indications. Variants of uncertain significance should not guide care, incidental germline findings require confirmatory germline testing, and WES/WGS and some MRD or other uses remain investigational or not medically necessary where clinical utility is unestablished.
"Detection of somatic oncogenic (driver) mutations in tumors to guide targeted therapy selection."