Anthem Blue Cross Connecticut GENE.00025 Proteogenomic Testing for the Evaluation of Malignancies Form

This document addresses proteogenomic testing for the evaluation of malignancies in individuals who have been diagnosed with cancer.

Proteogenomic tests include, but may not be limited to:

• DarwinOncoTarget^™ (Darwin Health, New York, NY)
• Genomic Proteomic Spectrometry, or GPS Cancer^™ test (NantHealth, Culver City, CA)

Position Statement

Investigational and Not Medically Necessary:

Proteogenomic testing is considered investigational and not medically necessary for all indications.