Anthem Blue Cross Connecticut LAB.00026 Systems Pathology and Multimodal Artificial Intelligence Testing for Prostate Cancer Form

This document addresses the use of the systems pathology method for individuals with prostate cancer. Systems pathology and multimodal artificial intelligence testing are computer-based diagnostic tools combining data using the cellular and biologic features of a pathological specimen, which may include computerized image analysis and quantitative immunofluorescence, in addition to clinical information, such as age and clinical or pathological stage, with the results of other lab tests to estimate the risk of prostate cancer progression, recurrence, metastasis, mortality or response to drug therapy.

Note: Please see the following related documents for additional information:

• LAB.00049 Artificial Intelligence-Based Software for Prostate Cancer Detection

Position Statement

Investigational and Not Medically Necessary:

Use of the laboratory tests using systems pathology and multimodal artificial intelligence methodology for individuals with prostate cancer is considered investigational and not medically necessary.