Gene Expression Profiling for Cancer Indications - MEDICAID - SOUTH CAROLINA

This policy addresses gene expression profiling tests for cancer indications — including use in diagnosis, prognostication, and treatment decision-making for conditions such as diffuse large B‑cell lymphoma, resected stage II colon cancer, cancers of unknown primary, prostate cancer (detection/active surveillance), cutaneous and uveal melanoma, pancreatic lesions, localized muscle‑invasive bladder cancer (neoadjuvant context), and tests used in early‑stage NSCLC. Major limitations include that the evidence is considered insufficient by CMS‑type standards to establish broad clinical utility, several specific assays are listed as excluded or limited (e.g., Oncotype DX Colon, myPath Melanoma, Genomic Prostate Score, DetermaRx, DecisionDx‑SCC), some tests (e.g., ExoDx Prostate/MPS2) have conditional coverage criteria, and coverage may vary by Humana plan with policy subject to periodic review.

"Benign but clinical suspicion of cancer persists; OR"