Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
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©2017 Blue Cross and Blue Shield of Louisiana An independent licensee of the Blue Cross and Blue Shield Association No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from Blue Cross and Blue Shield of Louisiana. Page 1 of 33 Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the “Company”), unless otherwise provided in the applicable contract. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically.
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Policy Number: 670 BCBSA Reference Number: 2.04.111 NCD/LCD: Local Coverage Determination (LCD): MolDX-CDD: Decipher Prostate Cancer Classifier Assay (L35868) Local Coverage Determination (LCD): MolDX-CDD: ProlarisTM Prostate Cancer Genomic Assay (L35869) Local Coverage Determination (LCD): MolDX: Prolaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease (L37...
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Policy Number: 670 BCBSA Reference Number: 2.04.111 NCD/LCD: Local Coverage Determination (LCD): MolDX-CDD: Decipher Prostate Cancer Classifier Assay (L35868) Local Coverage Determination (LCD): MolDX-CDD: ProlarisTM Prostate Cancer Genomic Assay (L35869) Local Coverage Determination (LCD): MolDX: Prolaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease (L37...
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