Molecular Biomarker Testing for Noncancer Indications - MEDICAID - VIRGINIA

This policy addresses molecular biomarker testing (including multianalyte serum assays, gene/chromosome/protein analyses and unlisted molecular pathology procedures) for noncancer indications such as risk assessment for type II diabetes, evaluation of inherited disorders (eg, GM2 gangliosidoses/Tay‑Sachs/Sandhoff, APOL1 for CKD risk), prenatal/preimplantation screening (eg, NIPS and second‑trimester multiple‑marker screens) and other screening, diagnostic or treatment‑decision uses (eg, cardiovascular biomarkers like ST2). Coverage is subject to member‑specific benefits and the policy’s Coverage Limitations: many tests are screening (not diagnostic) and may require confirmatory invasive testing, have timing or specimen constraints (eg, second‑trimester screens at ~15–20 weeks), and the policy does not guarantee reimbursement or override clinical judgment.

"81479: Unlisted molecular pathology procedure"