Medical Policy Updates

Notification of Policy Revisions Effective May 14, 2013 (Posted February 12, 2013)

Medical Policy	Revision
Assays of Genetic Expression to Determine Prognosis of Breast Cancer "Notification"	Description section revised. In the When Not Covered section added "1.c. Determination of recurrence risk in patients with bilateral disease;" "2. Use of a subset of genes from the 21-gene RT-PCR assay for predicting recurrence risk in patients with noninvasive ductal carcinoma in situ (i.e., Oncotype DX DCIS) to inform treatment planning following excisional surgery is considered investigational." and added NexCourse^® Breast IHC4 to the list in number 3. Senior Medical Director review 1/15/13. Reference added. Notification given 2/12/13, policy effective 5/14/2013.

Medical Policy

Revision

Assays of Genetic Expression to Determine Prognosis of Breast Cancer "Notification"

Description section revised. In the When Not Covered section added "1.c. Determination of recurrence risk in patients with bilateral disease;" "2. Use of a subset of genes from the 21-gene RT-PCR assay for predicting recurrence risk in patients with noninvasive ductal carcinoma in situ (i.e., Oncotype DX DCIS) to inform treatment planning following excisional surgery is considered investigational." and added NexCourse^® Breast IHC4 to the list in number 3. Senior Medical Director review 1/15/13. Reference added. Notification given 2/12/13, policy effective 5/14/2013.