Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut GENE.00009 Gene Expression Profiling and Genomic Biomarker Tests for Prostate Cancer Form

Effective Date

09/27/2023

Last Reviewed

02/16/2023

Original Document

  Reference



This document addresses gene expression and genomic biomarker tests for the screening, detection and management of prostate cancer. Gene expression profiles measure the activity of multiple genes (examples include the Prolaris® test [Myriad Genetics, Salt Lake City, Utah], Decipher® Prostate Cancer Classifier [Decipher Biosciences, San Diego, CA], and the Oncotype DX® Genomic Prostate Score [Genomic Health, Redwood City, CA]); genomic biomarker tests include, but are not limited to, assessment of gene hypermethylation, multi-gene expression profiles, prostate cancer antigen gene-3 (PCA3 [formerly known as DD3]), ribonucleic acid (RNA), and TMPRSS fusion genes.

Note: Please see the following related document(s) for additional information:

  • CG-GENE-14 Gene Mutation Testing for Cancer Susceptibility and Management
  • GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling
  • LAB.00015 Detection of Circulating Tumor Cells

Position Statement

Investigational and Not Medically Necessary:

Gene expression profiling and genomic biomarker tests as a technique for prostate cancer screening, detection and management are considered investigational and not medically necessary for all indications.