November 2025 Clinical Policy Review

The following clinical policies have undergone an annual review with some added criteria requirements that may impact the prior authorization process. Please see the revision log within each policy to review the changes:

• V1.2025 Concert Genetic Testing and Oncology
  • Aortopathies and Connective Tissue Disorders
  • Cardiac Disorders
  • Dermatologic Conditions
  • Epilepsy, Neurodegenerative, and Neuromuscular Conditions
  • Exome and Genome Sequencing for the Diagnosis of Genetic Disorders
  • Eye Disorders
  • Gastroenterologic Disorders (non-cancerous)
  • General Approach to Genetic and Molecular Testing
  • Hearing Loss
  • Hematologic Conditions (non-cancerous)
  • Hereditary Cancer Susceptibility 
  • Immune, Autoimmune, and Rheumatoid Disorders
  • Kidney Disorders
  • Lung Disorders
  • Metabolic, Endocrine, and Mitochondrial Disorders
  • Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
  • Prenatal Cell Free DNA
  • Non-Invasive Prenatal Screening (NIPS)
  • Pharmacogenetics (versions A & B))
  • Preimplantation Genetic Testing
  • Prenatal and Preconception Carrier Screening
  • Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss
  • Skeletal Dysplasia and Rare Bone Disorders
  • Algorithmic Testing
  • Cancer Screening
  • Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy)
  • Cytogenetic Testing
  • Molecular Analysis of Solid Tumors and Hematologic Malignancies

The following clinical policies have been adopted:

• CP.MP.251 - Radiation Therapy for Skin Cancer 
• CP.MP.127 - Total Artificial Heart
• CP.MP.101 - Donor Lymphocyte Infusion
• CP.MP.129 - Fetal Surgery in Utero for Prenatally Diagnosed Malformations
• CP.MP.147 - Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention
• CP.MP.160 - Implantable Wireless Pulmonary Artery Pressure Monitoring

These changes go into effect on January 1, 2026. Clinical policies are located on the Medical Policies page.