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

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.