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.