Molecular and Proteomic Diagnostic Testing for Hematology and Oncology Indications - (0520)

Cigna covers molecular, proteomic, gene‑expression classifier, ctDNA (liquid biopsy), MRD by high‑throughput immunosequencing and select circulating tumor cell testing (notably AR‑V7 for mCRPC) for oncology and hematology when specified general and disease‑specific criteria are met, while many named tests and numerous CPT/HCPCS codes (and most CTC testing other than AR‑V7) are explicitly not covered or considered investigational. Coverage requires documentation that the patient is a candidate for targeted therapy and that results will directly impact management, that the test has scientific validity and guideline/FDA or prospective evidence support (ctDNA only if tissue is unavailable/contraindicated and for advanced/metastatic disease or per FDA label; concurrent tissue+ctDNA within 30 days limited to metastatic breast and NSCLC; repeat testing requires a new sample and disease progression/non‑response; MRD/GEC/proteomic tests generally require NCCN category 1/2A/2B validation or equivalent evidence).