-
1199SEIU Benefit Funds Lab Policy Book
Effective 01/01/2020
-
4Kscore for Prostate Cancer Risk Assessment
Effective 01/01/2020
-
ABL Tyrosine Kinase Sequencing for Chronic Myeloid Leukemia
Effective 01/01/2020
-
Afirma Thyroid Cancer Classifer Tests
Effective 01/01/2020
-
AlloMap Gene Expression Profiling For Heart Transplant Rejection
Effective 01/01/2020
-
AlloSure
Effective 01/01/2020
-
Alpha-1 Antitrypsin Deficiency Testing
Effective 01/01/2020
-
AML Genetic Testing
Effective 01/01/2020
-
Amyotrophic Lateral Sclerosis ALS Genetic Testing
Effective 01/01/2020
-
Angelman Syndrome Testing
Effective 01/01/2020
-
Anser Testing
Effective 01/01/2020
-
APOE Variant Analysis for Alzheimer Disease
Effective 01/01/2020
-
Ashkenazi Jewish Carrier Screening
Effective 01/01/2020
-
AssureMDx
Effective 01/01/2020
-
Ataxia - Telangiectasia Testing
Effective 01/01/2020
-
BCR-ABL Negative Myeloproliferative
Effective 01/01/2020
-
BCR-ABL Testing for Chronic Myelogenous Leukemia
Effective 01/01/2020
-
Bloom Syndrome Testing
Effective 01/01/2020
-
BRAF Testing for Colorectal Cancer
Effective 01/01/2020
-
BRAF Testing for Melanoma Kinase Inhibitor Response
Effective 01/01/2020
-
BRCA Analysis
Effective 01/01/2020
-
BRCA Ashkenazi Jewish Founder Mutation Testing
Effective 01/01/2020
-
Breast Cancer Index for Breast Cancer Prognosis
Effective 01/01/2020
-
Brugada Syndrome Genetic Testing
Effective 01/01/2020
-
CADASIL Testing
Effective 01/01/2020
-
Canavan Disease Testing
Effective 01/01/2020
-
Celiac Disease Testing
Effective 01/01/2020
-
CellSearch Circulating Tumor Cell Count for Breast Cancer Prognosis
Effective 01/01/2020
-
Charcot-Marie-Tooth Neuropathy Testing
Effective 01/01/2020
-
Chromosomal Microarray for Prenatal Diagnosis
Effective 01/01/2020
-
Chromosomal Microarray Testing For Developmental Disorders
Effective 01/01/2020
-
Chromosome Analysis for Blood, Bone Marrow, and Solid Tumor Cancers
Effective 01/01/2020
-
Chromosome Analysis for Reproductive Disorders, Prenatal Testing, and Developmental Disorders
Effective 01/01/2020
-
Cologuard Screening for Colorectal Cancer
Effective 01/01/2020
-
Confirmatory Genetic Testing
Effective 01/01/2020
-
ConfirmMDx for Prostate Cancer Risk Assessment
Effective 01/01/2020
-
Corus CAD for Obstructive Coronary
Effective 01/01/2020
-
CXBladder
Effective 01/01/2020
-
CYP2C9 VKORC1 CYP4F2 Testing for Warfarin Response
Effective 01/01/2020
-
CYP2D6 Variant Analysis - Tamoxifen, Tetrabenazine, or Eliglustat
Effective 01/01/2020
-
Cystic Fibrosis Testing
Effective 01/01/2020
-
Decipher Prostate Cancer Classifier
Effective 01/01/2020
-
DecisionDx Uveal Melanoma
Effective 01/01/2020
-
Dentatorubral Pallidoluysian Atrophy Testing
Effective 01/01/2020
-
DermTech Pigmented Lesion Assay
Effective 01/01/2020
-
DPYD Variant Analysis for 5FU Toxicity
Effective 01/01/2020
-
Duchenne and Becker Muscular Dystrophy Testing
Effective 01/01/2020
-
Early Onset Familial Alzheimer Disease (EOFAD) Genetic Testing
Effective 01/01/2020
-
EGFR Testing for Non Small Cell Lung Cancer TKI Response
Effective 01/01/2020
-
Ehlers Danlos Syndrome Testing
Effective 01/01/2020
-
EndoPredict for Breast Cancer Prognosis
Effective 01/01/2020
-
Expanded Carrier Screening Panels
Effective 01/01/2020
-
Factor II Prothrombin Testing for Thrombophilia
Effective 01/01/2020
-
Factor V Leiden Testing for Thrombophilia
Effective 01/01/2020
-
Familial Adenomatous Polyposis Testing
Effective 01/01/2020
-
Familial Hypercholesterolemia Genetic Testing
Effective 01/01/2020
-
Familial Malignant Melanoma Testing
Effective 01/01/2020
-
FibroTest FibroSURE
Effective 01/01/2020
-
Flow Cytometry
Effective 01/01/2020
-
FoundationOne CDx
Effective 01/01/2020
-
Fragile X Associated Tremor Ataxia Syndrome Testing
Effective 01/01/2020
-
Fragile X Syndrome Testing
Effective 01/01/2020
-
Gaucher Disease Testing
Effective 01/01/2020
-
Genetic Presymptomatic and Predictive Testing for Adult Onset Conditions in Minors
Effective 01/01/2020
-
Genetic Testing by Multigene Panels
Effective 01/01/2020
-
Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy
Effective 01/01/2020
-
Genetic Testing for Autism
Effective 01/01/2020
-
Genetic Testing for Cancer Susceptibility and Hereditary Cancer Syndromes
Effective 01/01/2020
-
Genetic Testing for Carrier Status
Effective 01/01/2020
-
Genetic Testing for Dilated Cardiomyopathy
Effective 01/01/2020
-
Genetic Testing for Epilepsy
Effective 01/01/2020
-
Genetic Testing for Facioscapulohumeral Muscular Dystrophy
Effective 01/01/2020
-
Genetic Testing for Hereditary Pancreatitis
Effective 01/01/2020
-
Genetic Testing for Known Familial Mutations
Effective 01/01/2020
-
Genetic Testing for Limb Girdle Muscular Dystrophy
Effective 01/01/2020
-
Genetic Testing for Non Medical Purposes
Effective 01/01/2020
-
Genetic Testing for Nonsyndromic Hearing Loss and Deafness
Effective 01/01/2020
-
Genetic Testing for Prenatal Screening and Diagnostic Testing
Effective 01/01/2020
-
Genetic Testing for the Screening Diagnosis and Monitoring of Cancer
Effective 01/01/2020
-
Genetic Testing for Variants of Uncertain Clinical Significance
Effective 01/01/2020
-
Genetic Testing to Diagnose Non-Cancer Conditions
Effective 01/01/2020
-
Genetic Testing to Predict Disease Risk
Effective 01/01/2020
-
Genitourinary Conditions Molecular Testing
Effective 01/01/2020
-
GPS Cancer NantHealth
Effective 01/01/2020
-
Hereditary Cancer Syndrome Multigene Panels
Effective 01/01/2020
-
Hereditary Connective Tissue Disorder Testing
Effective 01/01/2020
-
Hereditary Germline Testing After Tumor Somatic Testing
Effective 01/01/2020
-
Hereditary Hemochromatosis Testing
Effective 01/01/2020
-
Hemoglobinopathies Genetic Testing
Effective 01/01/2020
-
Hereditary Ataxia Multigene Panel Testing
Effective 01/01/2020
-
HIV Tropism Testing for Maraviroc Response
Effective 01/01/2020
-
HLA B1502 Variant Analysis for Carbamazepine Response
Effective 01/01/2020
-
HLA B5701 Genotyping for Abacavir Hypersensitivity
Effective 01/01/2020
-
Huntington Disease
Effective 01/01/2020
-
Hypertrophic Cardiomyopathy Testing
Effective 01/01/2020
-
Immunohistochemistry (IHC)
Effective 01/01/2020
-
Information Requirements for Medical Necessity Review
Effective 01/01/2020
-
Investigational and Experimental Molecular and Genomic Testing
Effective 01/01/2020
-
KRAS Testing for Anti-EGFR Response in Metastatic Colorectal Cancer
Effective 01/01/2020
-
Laboratory Claim Reimbursement
Effective 01/01/2020
-
Leber Hereditary Optic Neuropathy (LHON) Genetic Testing
Effective 01/01/2020
-
Legius Syndrome Genetic Testing
Effective 01/01/2020
-
Li Fraumeni Syndrome
Effective 01/01/2020
-
Liquid Biopsy Testing Solid Tumors
Effective 01/01/2020
-
Long QT Syndrome Testing
Effective 01/01/2020
-
Lynch Syndrome Genetic Testing
Effective 01/01/2020
-
Lynch Syndrome Tumor Screening First Tier
Effective 01/01/2020
-
Lynch Syndrome Tumor Screening Second Tier
Effective 01/01/2020
-
Macula Risk
Effective 01/01/2020
-
Mammaprint 70 Gene Breast Cancer Recurrence Assay
Effective 01/01/2020
-
Mammostrat Breast Cancer Recurrence Assay
Effective 01/01/2020
-
Marfan Syndrome Genetic Testing
Effective 01/01/2020
-
Maturity Onset Diabetes of the Young MODY Testing
Effective 01/01/2020
-
MGMT Testing for Malignant Glioma Alkylating Agent Response
Effective 01/01/2020
-
Mitochondrial DNA Deletion Syndromes
Effective 01/01/2020
-
Mitochondrial Encephalomyopathy Lactic Acidosis and Strokelike Episodes MELAS Genetic Testing
Effective 01/01/2020
-
Mitochondrial Genetic Testing
Effective 01/01/2020
-
Mitochondrial Neurogastrointestinal Encephalopathy MNGIE
Effective 01/01/2020
-
Molecular Gastrointestinal Pathogen Panel GIPP Testing
Effective 01/01/2020
-
Molecular Pathology Tier 2 Molecular CPT Codes
Effective 01/01/2020
-
Molecular Respiratory Infection Pathogen Panel RIPP Testing
Effective 01/01/2020
-
MTHFR Variant Analysis for Hyperhomocysteinemia
Effective 01/01/2020
-
Multiple Endocrine Neoplasia Type 1 MEN1
Effective 01/01/2020
-
Multiple Endocrine Neoplasia Type 2 MEN2
Effective 01/01/2020
-
MUTYH Associated Polyposis Testing
Effective 01/01/2020
-
Myeloma Prognostic Risk Signature MyPRS
Effective 01/01/2020
-
Myoclonic Epilepsy with Ragged Red Fibers MERRF
Effective 01/01/2020
-
Myotonic Dystrophy Type 1 Genetic Testing
Effective 01/01/2020
-
myRisk Hereditary Cancer Testing
Effective 01/01/2020
-
NETest
Effective 01/01/2020
-
Neurofibromatosis Type 1 Genetic Testing
Effective 01/01/2020
-
Neurogenic Muscle Weakness Ataxia and Retinitis Pigmentosa NARP
Effective 01/01/2020
-
Niemann Pick Disease Types A and B Testing
Effective 01/01/2020
-
Niemann Pick Type C Testing
Effective 01/01/2020
-
Non Invasive Prenatal Screening
Effective 01/01/2020
-
Oncotype DX Breast DCIS
Effective 01/01/2020
-
Oncotype DX for Breast Cancer Prognosis
Effective 01/01/2020
-
Oncotype DX for Colorectal Cancer Recurrence Risk
Effective 01/01/2020
-
Oncotype DX for Prostate Cancer
Effective 01/01/2020
-
OVA1
Effective 01/01/2020
-
PALB2 Genetic Testing for Breast Cancer Risk
Effective 01/01/2020
-
PancraGEN
Effective 01/01/2020
-
PCA3 Testing for Prostate Cancer
Effective 01/01/2020
-
Peutz Jeghers Syndrome Testing
Effective 01/01/2020
-
Pharmacogenomic Testing for Drug Toxicity and Response
Effective 01/01/2020
-
Pharmacogenomic Testing Panels for Major Depressive Disorder
Effective 01/01/2020
-
Polymerase Gamma POLG Related Disorders Genetic Testing
Effective 01/01/2020
-
Prader Willi Syndrome Testing
Effective 01/01/2020
-
Preimplantation Genetic Screening and Diagnosis
Effective 01/01/2020
-
Prenatal Aneuploidy FISH Testing
Effective 01/01/2020
-
Prenatal Maternal Serum Screening
Effective 01/01/2020
-
Prolaris
Effective 01/01/2020
-
ProMark Proteomic Prognostic Test
Effective 01/01/2020
-
Prosigna Breast Cancer Prognostic Gene Signature Assay
Effective 01/01/2020
-
PTEN Hamartoma Tumor Syndrome Testing
Effective 01/01/2020
-
Rett Syndrome Testing
Effective 01/01/2020
-
RosettaGX Reveal
Effective 01/01/2020
-
SelectMDx
Effective 01/01/2020
-
SensiGene Fetal RHD Genotyping
Effective 01/01/2020
-
Sept9 Methylation Analysis for Colorectal Cancer
Effective 01/01/2020
-
Somatic Mutation Testing - Hematological Malignancies
Effective 01/01/2020
-
Somatic Mutation Testing - Solid Tumors
Effective 01/01/2020
-
Spinal Muscular Atrophy Testing
Effective 01/01/2020
-
Spinocerebellar Ataxia Genetic Testing
Effective 01/01/2020
-
Tay Sachs Disease Testing
Effective 01/01/2020
-
Thoracic Aortic Aneurysms and Dissections TAAD Panel Testing
Effective 01/01/2020
-
ThyGeNEXT and ThyraMIR miRNA Gene Expression Classifier
Effective 01/01/2020
-
ThyroSeq
Effective 01/01/2020
-
Tissue of Origin Testing for Cancer of Unknown Primary
Effective 01/01/2020
-
TPMT Testing for Thiopurine Drug Response
Effective 01/01/2020
-
UGT1A1 Mutation Analysis for Irinotecan Response
Effective 01/01/2020
-
Unique Test Identifiers for Non Specific Procedure Codes
Effective 01/01/2020
-
UroVysion FISH for Bladder Cancer
Effective 01/01/2020
-
VeriStrat Testing for NSCLC TKI Response
Effective 01/01/2020
-
Von Hippel Lindau Disease Testing
Effective 01/01/2020
-
Whole Exome Sequencing
Effective 01/01/2020
-
Whole Genome Sequencing
Effective 01/01/2020
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.