Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut LAB.00046 Testing for Biochemical Markers for Alzheimer’s Disease Form



Measurement of long form amyloid beta in the cerebrospinal fluid

Notes: Only covered when specific criteria are met.

Indications

(66768) Is the test being considered for a patient with planned treatment using amyloid beta targeting therapy, such as lecanemab-irmb (Leqembi™)? 

Measurement of biochemical markers for Alzheimer's disease diagnosis

Notes: Tests are investigative and not considered medically necessary when criteria for amyloid beta testing are not met.

Indications

(66769) Are the measurements intended to establish an Alzheimer’s disease diagnosis? 

Contraindications

(66770) Have the criteria for medically necessary measurement of long form amyloid beta been met? 

Screening Measurement of biochemical markers in asymptomatic individuals

Notes: Testing is deemed investigative and not medically necessary for screening purposes.

Indications

(66771) Is the patient asymptomatic and being screened for Alzheimer’s disease with or without a family history? 

Effective Date

01/03/2024

Last Reviewed

11/09/2023

Original Document

  Reference



This document addresses the use of testing for biochemical markers (for example, tau protein, long form amyloid beta, and neural thread protein) as a diagnostic or screening technique for Alzheimer’s disease.

Notes:

  • This document does not address imaging tests, including MRI and PET. For criteria related to MRI and PET, refer to applicable guidelines used by the plan.

Position Statement

Medically Necessary:

Measurement of long form amyloid beta (also referred to as Aβ, Aβ1-42, Beta-amyloid [1-42], and Abeta42) in the cerebrospinal fluid is considered medically necessary in individuals for whom treatment with amyloid beta targeting therapy (for example, lecanemab-irmb [Leqembi™]) is being considered.

Investigational and Not Medically Necessary:

Measurements of biochemical markers (including but not limited to tau protein, long form amyloid beta, neural thread protein) is considered investigational and not medically necessary as a diagnostic technique for individuals with symptoms suggestive of Alzheimer’s disease when the criteria above have not been met.

Measurements of biochemical markers as a screening technique in asymptomatic individuals with or without a family history of Alzheimer’s disease is considered investigational and not medically necessary.