Gene Expression Profiling for Cancer Indications - MEDICAID - VIRGINIA
HUMANA-GENE-EXPRESSION-PROFILING-FOR-CANCER-INDICATIONS-VA-MEDICAID
This policy covers gene expression profiling and related molecular assays (mRNA expression panels, methylation tests, and multiplex PCR/ddPCR-based tests) used to aid diagnosis, prognosis, surveillance, or management of cancers such as cutaneous squamous cell carcinoma, melanoma, prostate cancer, urothelial/bladder cancer, and breast cancer. Coverage is plan-dependent for Virginia Medicaid (Humana) members, many specific tests have exclusions or eligibility criteria (e.g., DecisionDx‑Melanoma, DecisionDx‑SCC, Cxbladder Triage Plus, Decipher Bladder TURBT, EarlyTect BCD, Genomic Prostate Score), and the policy cites insufficient evidence for some uses and allows clinical/plan-level review to modify coverage.
"ConfirmMDx (81551) to manage prostate biopsy results when any of the following indications are met:"
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