Medical Protocol Introduction


Our Corporate Medical Protocols provide a concise overview of the criteria used for clinical determinations for a member’s coverage.

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Medical Protocols


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Gastric Electrical Stimulation
Gene Expression Testing to Predict Coronary Artery Disease
Gene Expression-Based Assays for Cancers of Unknown Primary
Gene-Based Tests for Screening, Detection, and/or Management of Prostate Cancer
General Approach to Evaluating the Utility of Genetic Panels
General Approach to Genetic Testing
Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
Genetic Testing for Alpha-1 Antitrypsin Deficiency
Genetic Testing for Cardiac Ion Channelopathies
Genetic Testing for Duchenne and Becker Muscular Dystrophy
Genetic Testing for Familial Alzheimer’s Disease
Genetic Testing for Familial Cutaneous Malignant Melanoma
Genetic Testing for FMR1 Mutations (Including Fragile X Syndrome)
Genetic Testing for Hereditary Breast and/or Ovarian Cancer
Genetic Testing for Hereditary Hearing Loss
Genetic Testing for Hereditary Hemochromatosis
Genetic Testing for Inherited Thrombophilia
Genetic Testing for Lactase Insufficiency
Genetic Testing for Li-Fraumeni Syndrome
Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment
Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
Genetic Testing for Mental Health Conditions
Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
Genetic Testing for PTEN Hamartoma Tumor Syndrome
Genetic Testing for Rett Syndrome
Genetic Testing for Statin-Induced Myopathy
Genetic Testing for Tamoxifen Treatment
Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
Genetic Testing for Warfarin Dose
Genetic Testing of CADASIL Syndrome
Genetic Testing of Mitochondrial Disorders
Genetic Testing, Including Chromosomal Microarray Analysis and Next-Generation Sequencing Panels, for the Evaluation of Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and/or Congenital Anomalies
Genotyping for 9p21 Single Nucleotide Polymorphisms to Predict Risk of Cardiovascular Disease or Aneurysm

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