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Medical Policy Upcoming Updates

Notification Date: May 20, 2020

Below are the policies that are new or have been reviewed, along with the determination and summary of any changes.

Coverage Policies

Policy Title
Status
Effective Date
Determination
Summary of Change
Gene Expression Profiling for Melanoma New 07/20/2020 Covered for some indications; investigative and therefore not covered for all other indications
  • DecisionDx-UM (uveal melanoma) Assay is not investigative for assessment of patients diagnosed with primary, localized, non-metastatic uveal melanoma that has not been previously treated.
  • DecisionDx-UM (uveal melanoma) Assay is investigative for all other clinical presentations and conditions.
  • All other gene expression profiles for assessment of cutaneous or uveal melanoma are investigative for all indications, including but not limited to:
  1. DecisionDx-Melanoma
  2. Pigmented Lesion Assay (PLA)
  3. myPath® Melanoma
  4. DecisionDx-PRAME



The updated clinical policies and guidelines above will be available as of their effective date, as noted. View policies and guidelines.

To request paper copies of a policy, please leave a message at the Medica Provider Literature Request Line: 1-800-458-5512, option 1, then option 8, then ext. 2-2355.

Where information conflicts with applicable state and/or federal law, Medica follows such applicable federal and/or state law.


Date: 7/31/2021 10:42:46 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB02