Molecular Oncology Hematologic Cancer Diagnosis Cs
Defines UnitedHealthcare medical policy CS372.F regarding when multigene NGS panels, comprehensive genomic profiling (CGP), and clonality/MRD testing (clonoSEQ) are considered medically necessary or not, applicable to hematologic malignancies; includes applicable CPT/HCPCS proprietary codes and evidence background. Excludes specific states per application section.
Added language to clarify the use of multigene panels (50 genes or fewer) at initial diagnosis and/or recurrence or relapse is proven and medically necessary when ordered by a hematologist or oncologist for listed conditions.
Clonality assessment with clonoSEQ® at initial diagnosis and MRD assessment with clonoSEQ®: added criterion requiring the individual has chronic lymphocytic leukemia for some uses.
Replaced prior coverage language to state Comprehensive Genomic Profiling (CGP) is proven and medically necessary for individuals with ALL, AML, MDS, or myeloproliferative neoplasm.
Stated that molecular tests other than clonoSEQ are unproven and not medically necessary for initial clonality assessment or for assessment of MRD.
Removed content/language pertaining to the state of Louisiana.
Updated Clinical Evidence, FDA, and References sections to reflect current information.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.