-
1199SEIU Benefit Funds Lab Policy Book
Effective 07/01/2019
-
4Kscore for Prostate Cancer Risk Assessment
Effective 07/01/2019
-
ABL Tyrosine Kinase Sequencing for Chronic Myeloid Leukemia
Effective 07/01/2019
-
Afirma Thyroid Cancer Classifer Tests
Effective 07/01/2019
-
AlloMap Gene Expression Profiling For Heart Transplant Rejection
Effective 07/01/2019
-
AlloSure
Effective 07/01/2019
-
Alpha-1 Antitrypsin Deficiency Testing
Effective 07/01/2019
-
AML Genetic Testing
Effective 07/01/2019
-
Amyotrophic Lateral Sclerosis ALS Genetic Testing
Effective 07/01/2019
-
Angelman Syndrome Testing
Effective 07/01/2019
-
Anser Testing
Effective 07/01/2019
-
APOE Variant Analysis for Alzheimer Disease
Effective 07/01/2019
-
Ashkenazi Jewish Carrier Screening
Effective 07/01/2019
-
AssureMDx
Effective 07/01/2019
-
Ataxia - Telangiectasia Testing
Effective 07/01/2019
-
BCR-ABL Negative Myeloproliferative
Effective 07/01/2019
-
BCR-ABL Testing for Chronic Myelogenous Leukemia
Effective 07/01/2019
-
Bloom Syndrome Testing
Effective 07/01/2019
-
BRAF Testing for Colorectal Cancer
Effective 07/01/2019
-
BRAF Testing for Melanoma Kinase Inhibitor Response
Effective 07/01/2019
-
BRCA Analysis
Effective 07/01/2019
-
BRCA Ashkenazi Jewish Founder Mutation Testing
Effective 07/01/2019
-
Breast Cancer Index for Breast Cancer Prognosis
Effective 07/01/2019
-
Brugada Syndrome Genetic Testing
Effective 07/01/2019
-
CADASIL Testing
Effective 07/01/2019
-
Canavan Disease Testing
Effective 07/01/2019
-
Celiac Disease Testing
Effective 07/01/2019
-
CellSearch Circulating Tumor Cell Count for Breast Cancer Prognosis
Effective 07/01/2019
-
Charcot-Marie-Tooth Neuropathy Testing
Effective 07/01/2019
-
Chromosomal Microarray for Prenatal Diagnosis
Effective 07/01/2019
-
Chromosomal Microarray Testing For Developmental Disorders
Effective 07/01/2019
-
Chromosome Analysis for Blood, Bone Marrow, and Solid Tumor Cancers
Effective 07/01/2019
-
Chromosome Analysis for Reproductive Disorders, Prenatal Testing, and Developmental Disorders
Effective 07/01/2019
-
Cologuard Screening for Colorectal Cancer
Effective 07/01/2019
-
Confirmatory Genetic Testing
Effective 07/01/2019
-
ConfirmMDx for Prostate Cancer Risk Assessment
Effective 07/01/2019
-
Corus CAD for Obstructive Coronary
Effective 07/01/2019
-
CXBladder
Effective 07/01/2019
-
CYP2C19 Variant Analysis for Clopidogrel Response
Effective 07/01/2019
-
CYP2C9 VKORC1 CYP4F2 Testing for Warfarin Response
Effective 07/01/2019
-
CYP2D6 Variant Analysis - Tamoxifen, Tetrabenazine, or Eliglustat
Effective 07/01/2019
-
Cystic Fibrosis Testing
Effective 07/01/2019
-
Decipher Prostate Cancer Classifier
Effective 07/01/2019
-
DecisionDx Uveal Melanoma
Effective 07/01/2019
-
Dentatorubral Pallidoluysian Atrophy Testing
Effective 07/01/2019
-
DermTech Pigmented Lesion Assay
Effective 07/01/2019
-
DPYD Variant Analysis for 5FU Toxicity
Effective 07/01/2019
-
Duchenne and Becker Muscular Dystrophy Testing
Effective 07/01/2019
-
Early Onset Familial Alzheimer Disease (EOFAD) Genetic Testing
Effective 07/01/2019
-
EGFR Testing for Non Small Cell Lung Cancer TKI Response
Effective 07/01/2019
-
Ehlers Danlos Syndrome Testing
Effective 07/01/2019
-
EndoPredict for Breast Cancer Prognosis
Effective 07/01/2019
-
Expanded Carrier Screening Panels
Effective 07/01/2019
-
Factor II Prothrombin Testing for Thrombophilia
Effective 07/01/2019
-
Factor V Leiden Testing for Thrombophilia
Effective 07/01/2019
-
Familial Adenomatous Polyposis Testing
Effective 07/01/2019
-
Familial Hypercholesterolemia Genetic Testing
Effective 07/01/2019
-
Familial Malignant Melanoma Testing
Effective 07/01/2019
-
FibroTest FibroSURE
Effective 07/01/2019
-
Flow Cytometry
Effective 07/01/2019
-
FoundationOne CDx
Effective 07/01/2019
-
Fragile X Associated Tremor Ataxia Syndrome Testing
Effective 07/01/2019
-
Fragile X Syndrome Testing
Effective 07/01/2019
-
Gaucher Disease Testing
Effective 07/01/2019
-
Genetic Presymptomatic and Predictive Testing for Adult Onset Conditions in Minors
Effective 07/01/2019
-
Genetic Testing by Multigene Panels
Effective 07/01/2019
-
Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy
Effective 07/01/2019
-
Genetic Testing for Autism
Effective 07/01/2019
-
Genetic Testing for Cancer Susceptibility and Hereditary Cancer Syndromes
Effective 07/01/2019
-
Genetic Testing for Carrier Status
Effective 07/01/2019
-
Genetic Testing for Dilated Cardiomyopathy
Effective 07/01/2019
-
Genetic Testing for Epilepsy
Effective 07/01/2019
-
Genetic Testing for Facioscapulohumeral Muscular Dystrophy
Effective 07/01/2019
-
Genetic Testing for Hereditary Pancreatitis
Effective 07/01/2019
-
Genetic Testing for Known Familial Mutations
Effective 07/01/2019
-
Genetic Testing for Limb Girdle Muscular Dystrophy
Effective 07/01/2019
-
Genetic Testing for Non Medical Purposes
Effective 07/01/2019
-
Genetic Testing for Nonsyndromic Hearing Loss and Deafness
Effective 07/01/2019
-
Genetic Testing for Prenatal Screening and Diagnostic Testing
Effective 07/01/2019
-
Genetic Testing for the Screening Diagnosis and Monitoring of Cancer
Effective 07/01/2019
-
Genetic Testing for Variants of Uncertain Clinical Significance
Effective 07/01/2019
-
Genetic Testing to Diagnose Non-Cancer Conditions
Effective 07/01/2019
-
Genetic Testing to Predict Disease Risk
Effective 07/01/2019
-
Genitourinary Conditions Molecular Testing
Effective 07/01/2019
-
GPS Cancer NantHealth
Effective 07/01/2019
-
Hereditary Cancer Syndrome Multigene Panels
Effective 07/01/2019
-
Hereditary Connective Tissue Disorder Testing
Effective 07/01/2019
-
Hereditary Germline Testing After Tumor Somatic Testing
Effective 07/01/2019
-
Hereditary Hemochromatosis Testing
Effective 07/01/2019
-
HIV Tropism Testing for Maraviroc Response
Effective 07/01/2019
-
HLA B1502 Variant Analysis for Carbamazepine Response
Effective 07/01/2019
-
HLA B5701 Genotyping for Abacavir Hypersensitivity
Effective 07/01/2019
-
Huntington Disease
Effective 07/01/2019
-
Hypertrophic Cardiomyopathy Testing
Effective 07/01/2019
-
Immunohistochemistry (IHC)
Effective 07/01/2019
-
Information Requirements for Medical Necessity Review
Effective 07/01/2019
-
Investigational and Experimental Molecular and Genomic Testing
Effective 07/01/2019
-
KRAS Testing for Anti-EGFR Response in Metastatic Colorectal Cancer
Effective 07/01/2019
-
Laboratory Claim Reimbursement
Effective 07/01/2019
-
Leber Hereditary Optic Neuropathy (LHON) Genetic Testing
Effective 07/01/2019
-
Legius Syndrome Genetic Testing
Effective 07/01/2019
-
Li Fraumeni Syndrome
Effective 07/01/2019
-
Liquid Biopsy Testing Solid Tumors
Effective 07/01/2019
-
Long QT Syndrome Testing
Effective 07/01/2019
-
Lynch Syndrome Genetic Testing
Effective 07/01/2019
-
Lynch Syndrome Tumor Screening First Tier
Effective 07/01/2019
-
Lynch Syndrome Tumor Screening Second Tier
Effective 07/01/2019
-
Macula Risk
Effective 07/01/2019
-
Mammaprint 70 Gene Breast Cancer Recurrence Assay
Effective 07/01/2019
-
Mammostrat Breast Cancer Recurrence Assay
Effective 07/01/2019
-
Marfan Syndrome Genetic Testing
Effective 07/01/2019
-
Maturity Onset Diabetes of the Young MODY Testing
Effective 07/01/2019
-
MGMT Testing for Malignant Glioma Alkylating Agent Response
Effective 07/01/2019
-
Mitochondrial DNA Deletion Syndromes
Effective 07/01/2019
-
Mitochondrial Encephalomyopathy Lactic Acidosis and Strokelike Episodes MELAS Genetic Testing
Effective 07/01/2019
-
Mitochondrial Genetic Testing
Effective 07/01/2019
-
Mitochondrial Neurogastrointestinal Encephalopathy MNGIE
Effective 07/01/2019
-
Molecular Gastrointestinal Pathogen Panel GIPP Testing
Effective 07/01/2019
-
Molecular Pathology Tier 2 Molecular CPT Codes
Effective 07/01/2019
-
Molecular Respiratory Infection Pathogen Panel RIPP Testing
Effective 07/01/2019
-
MTHFR Variant Analysis for Hyperhomocysteinemia
Effective 07/01/2019
-
Multiple Endocrine Neoplasia Type 1 MEN1
Effective 07/01/2019
-
Multiple Endocrine Neoplasia Type 2 MEN2
Effective 07/01/2019
-
MUTYH Associated Polyposis Testing
Effective 07/01/2019
-
Myeloma Prognostic Risk Signature MyPRS
Effective 07/01/2019
-
Myoclonic Epilepsy with Ragged Red Fibers MERRF
Effective 07/01/2019
-
myRisk Hereditary Cancer Testing
Effective 07/01/2019
-
NETest
Effective 07/01/2019
-
Neurofibromatosis Type 1 Genetic Testing
Effective 07/01/2019
-
Neurogenic Muscle Weakness Ataxia and Retinitis Pigmentosa NARP
Effective 07/01/2019
-
Niemann Pick Disease Types A and B Testing
Effective 07/01/2019
-
Niemann Pick Type C Testing
Effective 07/01/2019
-
Non Invasive Prenatal Screening
Effective 07/01/2019
-
Oncotype DX Breast DCIS
Effective 07/01/2019
-
Oncotype DX for Breast Cancer Prognosis
Effective 07/01/2019
-
Oncotype DX for Colorectal Cancer Recurrence Risk
Effective 07/01/2019
-
Oncotype DX for Prostate Cancer
Effective 07/01/2019
-
OVA1
Effective 07/01/2019
-
PALB2 Genetic Testing for Breast Cancer Risk
Effective 07/01/2019
-
PancraGEN
Effective 07/01/2019
-
PCA3 Testing for Prostate Cancer
Effective 07/01/2019
-
Peutz Jeghers Syndrome Testing
Effective 07/01/2019
-
Pharmacogenomic Testing for Drug Toxicity and Response
Effective 07/01/2019
-
Pharmacogenomic Testing Panels for Major Depressive Disorder
Effective 07/01/2019
-
Prader Willi Syndrome Testing
Effective 07/01/2019
-
Preimplantation Genetic Screening and Diagnosis
Effective 07/01/2019
-
Prenatal Aneuploidy FISH Testing
Effective 07/01/2019
-
Prenatal Maternal Serum Screening
Effective 07/01/2019
-
Prolaris
Effective 07/01/2019
-
ProMark Proteomic Prognostic Test
Effective 07/01/2019
-
Prosigna Breast Cancer Prognostic Gene Signature Assay
Effective 07/01/2019
-
PTEN Hamartoma Tumor Syndrome Testing
Effective 07/01/2019
-
Rett Syndrome Testing
Effective 07/01/2019
-
RosettaGX Reveal
Effective 07/01/2019
-
SelectMDx
Effective 07/01/2019
-
SensiGene Fetal RHD Genotyping
Effective 07/01/2019
-
Sept9 Methylation Analysis for Colorectal Cancer
Effective 07/01/2019
-
Somatic Mutation Testing - Solid Tumors
Effective 07/01/2019
-
Spinal Muscular Atrophy Testing
Effective 07/01/2019
-
Tay Sachs Disease Testing
Effective 07/01/2019
-
Thoracic Aortic Aneurysms and Dissections TAAD Panel Testing
Effective 07/01/2019
-
ThyGeNEXT and ThyraMIR miRNA Gene Expression Classifier
Effective 07/01/2019
-
ThyroSeq
Effective 07/01/2019
-
Tissue of Origin Testing for Cancer of Unknown Primary
Effective 07/01/2019
-
TPMT Testing for Thiopurine Drug Response
Effective 07/01/2019
-
UGT1A1 Mutation Analysis for Irinotecan Response
Effective 07/01/2019
-
Unique Test Identifiers for Non Specific Procedure Codes
Effective 07/01/2019
-
UroVysion FISH for Bladder Cancer
Effective 07/01/2019
-
VeriStrat Testing for NSCLC TKI Response
Effective 07/01/2019
-
Von Hippel Lindau Disease Testing
Effective 07/01/2019
-
Whole Exome Sequencing
Effective 07/01/2019
PROVIDERS
Clinical
Guidelines
Laboratory Management
Search by health plan name to view clinical guidelines. Adobe PDF Reader is required to view clinical guideline documents.
Benefits, coverage policies, and eligibility issues pertaining to each health plan may take precedence over eviCore’s clinical guidelines.
If an adverse determination is issued, the requesting provider will receive written notice by fax or email.