LAB.00042 Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy

This policy addresses molecular signature (e.g., gene expression) tests used to predict response to tumor necrosis factor inhibitor (TNFi) therapy, including for rheumatoid arthritis. Anthem deems these tests investigational/experimental and not medically necessary for all uses; they are not covered, including for guiding RA treatment selection. There are no covered indications or exceptions; related claims (e.g., CPT/HCPCS 81479, 81599; references L39424, L39427, L39467, L39469, L39481) may be denied as investigational.

"Molecular signature testing to predict response to Tumor Necrosis Factor inhibitor (TNFi) therapy is consideredinvestigational and not medically necessaryfor all uses, including but not limited to ..."

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