Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers multigene panels (≤50 genes) at initial diagnosis and/or relapse for AML, ALL, multiple myeloma, and when MDS/MPN is strongly suspected; it also covers clonoSEQ Clonality ID at diagnosis and clonoSEQ MRD for MRD monitoring in ALL and multiple myeloma, and Comprehensive Genomic Profiling only for relapsed/recurrent AML — all other molecular tests/panels (including optical genome mapping, whole transcriptome sequencing) and MRD assays other than clonoSEQ MRD are considered unproven and not medically necessary. Coverage requires an order from a hematologist/oncologist with documentation of the clinical indication (diagnosis/relapse or strong suspicion, baseline clonality/sample documentation for clonoSEQ, relapsed/recurrent status for CGP) and is subject to member benefits, prior authorization, and medical record review.

"Use of multigene panels (50 genes or fewer) at initial diagnosis and/or recurrence or relapse is proven and medically necessary when ordered by a hematologist or oncologist for individuals with: Ac..."