Medical Policy Updates

Notification of Policy Revisions Effective July 19, 2011 (Posted April 12, 2011)

Medical Policy	Revision
Use of Common Genetic Variants to Predict Risk of Nonfamilial Breast Cancer	New policy implemented. Use of common genetic variants by testing for one or more single nucleotide polymorphisms (SNPs) to predict an individual's risk of breast cancer is considered investigational. Notice given 4/12/2011. Policy effective 7/19/2011.
Epidermal Growth Factor Receptor (EGFR) Mutation Analysis for Patients with Non-Small Cell Lung Cancer (NSCLC)	New policy. Medical Director review 3/23/11. "Except as noted below, analysis of two types of somatic mutation within the EGFR gene small deletions in exon 19 and a point mutation in exon 21 (L858R) may be considered medically necessary to predict treatment response to erlotinib in patients with advanced NSCLC." "Analysis of two types of somatic mutation within the EGFR gene small deletions in exon 19 and a point mutation in exon 21 (L858R) is considered investigational for patients with advanced NSCLC of squamous cell-type." "Analysis for other mutations within exons 18-24, or other applications related to NSCLC, is considered investigational." Notification given 4/12/2011. Policy effective 7/19/2011.

Medical Policy

Revision

Use of Common Genetic Variants to Predict Risk of Nonfamilial Breast Cancer

New policy implemented. Use of common genetic variants by testing for one or more single nucleotide polymorphisms (SNPs) to predict an individual's risk of breast cancer is considered investigational. Notice given 4/12/2011. Policy effective 7/19/2011.

Epidermal Growth Factor Receptor (EGFR) Mutation Analysis for Patients with Non-Small Cell Lung Cancer (NSCLC)

New policy. Medical Director review 3/23/11. "Except as noted below, analysis of two types of somatic mutation within the EGFR gene small deletions in exon 19 and a point mutation in exon 21 (L858R) may be considered medically necessary to predict treatment response to erlotinib in patients with advanced NSCLC." "Analysis of two types of somatic mutation within the EGFR gene small deletions in exon 19 and a point mutation in exon 21 (L858R) is considered investigational for patients with advanced NSCLC of squamous cell-type." "Analysis for other mutations within exons 18-24, or other applications related to NSCLC, is considered investigational." Notification given 4/12/2011. Policy effective 7/19/2011.