Anthem Blue Cross Connecticut LAB.00041 Machine Learning Derived Probability Score for Rapid Kidney Function Decline Form

This document addresses the use of a machine learning derived probability score (i.e., artificial intelligence) which may combine a variety of clinical characteristics such as, biomarkers, genetics, gender or race, to generate prognostic information with the end-goal of facilitating a more personalized approach to the management of chronic kidney disease (e.g., KidneyIntelX^™). This document does not address the standard use of blood-based biomarkers, estimated glomerular filtration rate (eGFR) or urinary albumin and creatinine levels in the prognostic evaluation of newly diagnosed kidney disease.

Position Statement

Investigational and Not Medically Necessary:

Use of a machine learning derived probability score (e.g., KidneyIntelX) to predict rapid kidney function decline in chronic kidney disease is considered investigational and not medically necessary for all indications.