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

UnitedHealthcare covers selected non‑FDA companion molecular tests for specific, evidence‑based indications — e.g., breast GEPs (Oncotype DX, MammaPrint, Prosigna, BCI, EndoPredict) for ER+/HER2‑ early invasive breast cancer to inform adjuvant chemotherapy or extended endocrine therapy, lung multigene profiling ≤50 genes for NSCLC, prostate GEPs (GPS, Prolaris, Decipher) for untreated localized prostate cancer with defined risk groups, thyroid indeterminate nodule tests (Afirma GSC, ThyroSeq V3) for Bethesda III/IV, CGP for anaplastic thyroid, and DecisionDx‑UM for localized uveal melanoma — while deeming many other tests unproven/not covered (e.g., NGS/CGP panels >50 genes unless specified, MRD assays, multi‑cancer early detection tests, and numerous named commercial assays). Coverage requires specific documentation (diagnosis/pathology/cytology, staging and receptor status, ordering provider specialty, life expectancy and treatment intent), evidence that results will guide a particular treatment decision, specimen adequacy, and adherence to the policy’s listed clinical criteria.