Medical Policies

The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. Medical decisions relative to medical technologies are to be made strictly by members/patients in consultation with their health care providers. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that the Blue Cross and Blue Shield Service Benefit Plan covers (or pays for) this service or supply for a particular member.

2.04.32 Measurement of Lipoprotein-Associated Phospholipase A2 in the Assessment of Cardiovascular Risk
2.04.33 Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
2.04.36 Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer
2.04.38 Cytochrome P450 Genotype-Guided Treatment Strategy
2.04.41 Noninvasive Techniques for the Evaluation and Monitoring of Patients With Chronic Liver Disease
2.04.43 Genetic Testing for Cardiac Ion Channelopathies
2.04.44 Germline Genetic Testing for Familial Cutaneous Malignant Melanoma
2.04.45 Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in
2.04.48 Genotype-Guided Warfarin Dosing
2.04.51 Genotype-Guided Tamoxifen Treatment
2.04.52 Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, and Solid Pancreaticobiliary Lesions
2.04.53 Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Metastatic Colorectal Cancer (KRAS, NRAS, BRAF, and HER2)
2.04.54 Gene Expression-Based Assays for Cancers of Unknown Primary
2.04.56 Immune Cell Function Assay
2.04.58 Nerve Fiber Density Measurement
2.04.59 Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies
2.04.60 JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms
2.04.61 Gene Expression Profile Testing and Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer
2.04.62 Multimarker Serum Testing Related to Ovarian Cancer
2.04.63 Use of Common Genetic Variants (Single Nucleotide Variants) to Predict Risk of Nonfamilial Breast Cancer
2.04.65 Novel Biomarkers in Risk Assessment and Management of Cardiovascular Disease
2.04.66 Serum Biomarker Human Epididymis Protein 4
2.04.68 Laboratory and Genetic Testing for Use of 5-Fluorouracil in Patients with Cancer
2.04.73 Intracellular Micronutrient Analysis
2.04.75 Genetic Testing of CADASIL Syndrome
2.04.77 Somatic Genetic Testing to Select Individuals with Melanoma or Glioma for Targeted Therapy (BRAF)
2.04.78 Molecular Markers in Fine Needle Aspiration of the Thyroid
2.04.79 Genetic Testing for Alpha-1 Antitrypsin Deficiency
2.04.82 Genetic Testing for Inherited Thrombophilia
2.04.83 Genetic Testing for FMR1 Variants (Including Fragile X Syndrome)
2.04.84 Measurement of Serum Antibodies to Selected Biologic Agents
2.04.85 BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia
2.04.86 Genetic Testing for Duchenne and Becker Muscular Dystrophy
2.04.87 Genetic Testing for Hereditary Hearing Loss
2.04.88 Genetic Testing for PTEN Hamartoma Tumor Syndrome
2.04.89 Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
2.04.93 Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
2.04.95 Human Leukocyte Antigen Testing for Celiac Disease
2.04.96 Genetic Testing for Statin-Induced Myopathy
2.04.97 Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification
2.04.98 Drug Testing in Pain Management and Substance Use Disorder Treatment
2.04.99 Genetic Testing for Hereditary Pancreatitis
2.04.100 Cardiovascular Risk Panels
2.04.101 Genetic Testing for Li-Fraumeni Syndrome
2.04.102 Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders
2.04.103 Genetic Testing for Macular Degeneration
2.04.104 Genetic Testing for α-Thalassemia
2.04.105 Genetic Testing for Facioscapulohumeral Muscular Dystrophy
2.04.106 Genetic Testing for CHARGE Syndrome
2.04.107 Carrier Screening for Genetic Diseases