MolDX: Plasma-Based Genomic Profiling in Solid Tumors

This policy provides limited coverage for plasma-based NGS (liquid biopsy) assays such as Guardant360 for patients with recurrent/relapsed/refractory/metastatic/advanced non‑CNS solid tumors when tissue CGP is infeasible or (in NSCLC) shows no actionable mutations. Coverage requires that the patient seeks further treatment with a therapy whose FDA approval or NCCN 1/2A recommendation is biomarker‑based, that the patient has not previously had Guardant360 for the same genetic content (or has documented tumor evolution to justify repeat testing), and that documentation supports these conditions; other liquid assays may be covered if they demonstrate comparable performance to Guardant360.

"Patient has a recurrent, relapsed, refractory, metastatic, or advanced solid tumor that did not originate from the central nervous system."

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