Medical Policy Updates - Regence

Commercial medical policies - changes effective July 1, 2019

Genetic Testing

  • Chromosomal Microarray Analysis (CMA) for the Genetic Evaluation of Patients with Developmental Delay, Intellectual Disability, Autism Spectrum Disorder, or Congenital Anomalies (#58)
    • Changed policy name
    • Added to the medical necessity criteria testing of adults for the same indications as testing of pediatric patients
  • Evaluating the Utility of Genetic Panels (#64)
    • Added 13 investigational panels
    • Removed four investigational panels


  • Laboratory Tests for Heart and Kidney Transplant Rejection (#51)
    • Changed policy name
    • Added donor-derived cell-free DNA testing for kidney transplant

Medicare advantage medical policies - Changes effective July 1, 2019

Genetic Testing

  • Genetic and Molecular Diagnostics – Next Generation Sequencing and Genetic Panel Testing (Medicare #64)
    • Revised row for BDX-XL2 to direct the user to medical policy Genetic and Molecular Diagnostic Testing (Medicare Genetic Testing #20)
    • Revised wording for ColoNext test; the same local coverage determination (LCD) and criteria are used but we clarified how the LCD is to be applied
    • Added new third quarter 2019 codes


  • Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer (Medicare #60)
    • LCD L35000 was removed and local coverage article (LCA) A56199 was added to address CPT 81500
    • Added LCD L35396 to the row for ROMA testing performed in certain service areas


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