Humana In Vitro Chemoresistance and Chemosensitivity Assays Form

Description

In vitro chemoresistance and chemosensitivity assays are laboratory tests that compare a variety of chemotherapeutic agents performed on a tumor sample to allegedly determine which drugs may effectively or ineffectively inhibit tumor growth. While both are similar, they each offer different results. Chemoresistance assays supposedly determine which drugs are ineffective and chemosensitivity assays purportedly provide results for those that are effective. Laboratories often use different methodologies and processes (eg, staining techniques, tumor cloning or motility contrast tomography) to measure sensitivity and resistance.

Some laboratories offer molecular profiling tests (also referred to as genomic profiling tests) conjunctively or as a reflex test to in vitro chemoresistance and chemosensitivity assays. For information regarding molecular (genomic) profiling tests, please refer to Comprehensive Molecular Profiling for Hematologic Malignancies and Solid Tumors Medical Coverage Policy.

Coverage Determination

Humana members may NOT be eligible under the Plan for in vitro chemoresistance or chemosensitivity assays including, but may not be limited to:

• 3D Predict assays (eg, Glioma Panel [0248U], Ovarian Doublet Panel [0324U], Ovarian PARP Panel [0325U])
• ChemoFx assay, tumor drug response testing (81535 and 81536)
• Chemotherapeutic drug cytotoxicity assay of cancer stem cells (CSCs), from cultured CSCs and primary tumor cells (eg, ChemoID [0564T], Tumor stem cell assay)
• Chemotherapy Resistance Test (CTR-Test)
• Differential staining cytotoxic (DiSC) assay
• Fluorescent cytoprint assay (FCA)
• Human tumor cloning assay (HTCA)
• Live tumor cell culture and chemotherapeutic response by DAPI stain and morphology for gynecologic cancer
• Methyl thiazolyl-diphenyl-tetrazolium bromide (MTT) assay
• Microculture-kinetic (MiCK) assay
• Onco4D, Response to chemotherapy drugs using motility contrast tomography (0083U)

These are considered experimental/investigational as they are not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.

Note: The coverage determination for fluorescent cytoprint assay (also referred to as human tumor stem cell drug sensitivity assay) is consistent with the Medicare National Coverage Policy, and therefore applies to Medicare members.

Additional information about in vitro chemoresistance and chemosensitivity assays may be found from the following websites:

Background

• American Cancer Society
• American Society of Clinical Oncology
• National Cancer Institute
• National Comprehensive Cancer Network
• National Library of Medicine

Medical Alternatives

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Humana may offer a disease management program for this condition.

The member may call the number on his/her identification card to ask about our programs to help manage his/her care.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.