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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

4Kscore Test Medicare
Comprehensive Genetic Testing
Prenatal Genetic Testing
Oncologic Genetic Testing

Laboratory

APC &  MUTYH Gene Testing
Alpha-1 Antitrypsin Deficiency Testing
AlloSure Donor-Derived Cell-Free DNA Test
Acute Myeloid Leukemia Genetic Testing
Allergy Testing
ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP)
Anthem
Aetna
FloridaBlue
Atherosclerotic Cardiovascular Disease Risk Assessment
Cigna
Aetna
BRAF Mutation Analysis
Biomarkers for Oncology: Hairy Cell Leukemia
Biomarkers for Oncology: Colorectal Cancer
Biomarkers for Oncology: Chronic Lymphoid Leukemia (CLL)
Biomarkers in Cardiovascular Risk Assessment
Biomarkers for Oncology: Brain
BCR-ABL1 Testing in Chronic Myelogenous Leukemia & Acute Lymphoblastic Leukemia
Biomarkers for Oncology: Acute Lymphoid Leukemia (ALL)
Brain Natriuretic Peptide (BNP)
Biomarkers for Oncology: Urinary tract
Biomarker Testing for Multiple Sclerosis & Related Neurologic Diseases
Biomarkers for Oncology: Uterus/Ovary/
Fallopian Tube/
Peritoneum
Biomarkers for Oncology: Melanoma
Biomarkers for Oncology: Non-Small Cell Lung Cancer (NSCLC)
Breast Cancer Index Genetic Assay
B-Type Natriuretic Peptide (BNP)
Gene Expression Profiling for Managing Breast Cancer Treatment
BRCA1 & BRCA2 Genetic Testing
Breast Cancer Assay: Prosigna
Assays of Genetic Expression in Tumor Tissue to Determine Prognosis in Patients with Breast Cancer
Breast Cancer Index Genetic Assay
FloridaBlue
Anthem
Anthem
FloridaBlue
Bladder Tumor Markers
Carrier Screening in Pregnancy
Celiac Disease Testing
Cardiovascular Disease (CVD) Risk Testing
CADASIL Syndrome Genetic Testing
Hereditary Cardiomyopathie s
 (including ARVD/C)
Genetic Testing for Diagnosis & Management
Cancer Susceptibility and Management Gene Mutation Testing for Solid Tumor Cancer
Cardiac Ion Channel Genetic Testing
Anthem
Humana
COVID-19
In Vitro Diagnostic Testing
Creatine Kinase (CK), (CPK)
Controlled Substance Monitoring & Drugs of Abuse Testing
Chromosome Microarray Testing (Non-Oncology Conditions)
Circulating Tumor Cell Testing
Colorectal Cancer: 
Biomarkers for Oncology
UHC
FloridaBlue
Aetna
Cytogenetic Studies
Cystatin C Measurement
Carrier Screening in the Prenatal Setting & Preimplantation Genetic Testing
Anthem
Carrier Testing for Genetic Diseases
UHC
Chromosome 1p/19q Deletion Analysis
CHARGE Syndrome Genetic Testing
Cell-free Fetal DNA Testing
Cell-free DNA Testing for the Management of Cancer
Chromosomal Microarray Analysis (CMA) for Developmental Delay, Autism Spectrum Disorder, Intellectual Disability & Congenital Anomalies
Anthem
Anthem
UHC
Anthem
Circulating Tumor DNA Panel Testing (Liquid Biopsy)
Anthem
ConfirmMDx Epigenetic Molecular Assay
Comparative Genomic Hybridization (CGH) - Chromosomal Microarray Analysis (CMA) for Selected Hereditary Conditions
Cutaneous Malignant Melanoma-
Genetic Testing
CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing
Cystic Fibrosis Genetic Testing
Alpha-Fetoprotein Testing -
Outpatient
Anthem
Genetic Testing
Aetna
Decipher® Prostate Cancer Classifier Assay
Drug Testing
DecisionDx-Melanoma
Aetna
Drug Testing in Pain Management & Substance Use Disorder Treatment
Outpatient Testing for Drugs of Abuse
Aetna
FloridaBlue
Erythrocyte Sedimentation Rate
Fetal Fibronectin Enzyme Immunoassay
Thyroid Fine Needle Aspirate Molecular Markers
Fecal Calprotectin Testing
Flow cytometry: Cell surface, cytoplasmic, or nuclear marker
Flow Cytometry
Flow cytometry: Cell cycle or DNA analysis
Folate Testing
FloridaBlue
UHC
FloridaBlue
Aetna
Genetic Testing for Inherited Diseases
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)
Genitourinary Conditions 
Testing
Genotype Testing for Individual Genetic Polymorphisms to Determine Drug Metabolizer Status
Gastrointestinal Pathogen Panel (GIPP) Testing for Infectious Diarrhea in the Outpatient Setting
Anthem
Anthem
PTEN Hamartoma Tumor Syndrome Genetic Testing
Anthem
Anthem
Measurable Residual Disease Assessment in Lymphoid Cancers Using Next Generation Sequencing
Anthem
BDX-XL2 Assay
Medicare
Decipher Biopsy Prostate Cancer Classifier Assay for Men with Very Low & Low Risk Disease
DecisionDx-UM (Uveal Melanoma)
EndoPredict Breast Cancer Gene Expression Test
DNA Analysis of Stool to Screen for Colorectal Cancer
Duchenne, Becker, Facioscapulohumeral, & Limb-Girdle Muscular Dystrophies Genetic Testing
Ehlers-Danlos Syndrome 
Genetic Testing
Endocrine Gland Cancer Susceptibility 
Genetic Testing
Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
Epilepsy Genetic Testing
Fanconi Anemia Genetic Testing
Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs)
FMR1 mutations (including Fragile X Syndrome) Genetic Testing
GeneSight Assay for Refractory Depression
BCR-ABL Negative Myeloproliferative Disease 
Genetic Testing
Genetic Testing for Breast, Ovarian and Pancreatic Cancer Susceptibility
Humana
UHC
Cardiac Disease 
Genetic Testing
Catecholaminergic Polymorphic Ventricular Tachycardia Genetic Testing
Genetic Testing for Diagnosis and Monitoring of Cancer
Humana
Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, & MTHFR)
Genetic Testing for Inherited Conditions
Anthem
Genetic Testing for Lynch Syndrome, Familial Adenomatous Polyposis (FAP), Attenuated FAP & MYH-associated Polyposis
Genetic Testing for Lynch Syndrome & Other Inherited Colon Cancer Syndromes
Anthem
FloridaBlue
Genetic Testing for Neurode-generative Disorders
Genetic Testing for TP53 Mutations
Anthem
Genomic Health™ Oncotype DX® Prostate Cancer Assay
Germline Mutations of the RET Proto-Oncogene Genetic Testing
Glioma Molecular Analysis
Guardant360 Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)
Outpatient Glycated Hemoglobin & Protein Testing 
(HbA1c)
Anthem
HbA1c
Heavy Metal Testing
Helicobacter Pylori Infection Testing
Hematopoietic Cell Transplantation for CNS Embryonal Tumors & Ependymoma
Hepatic (Liver) Function Panel
Hepatitis B Surface Antibody
Hepatitis Screening
UHC
Hepatitis B Surface Antigen
Hereditary Cancer Testing
Hereditary Hearing Loss Genetic Testing
Hereditary Hemochromatosis Genetic Testing
Hereditary Pancreatitis Genetic Testing
Heterozygous Familial Hypercho-lesterolemia Genetic Testing
Heritable Cardiac Conditions 
Genetic Testing
Anthem
Anthem
High Sensitivity C-Reactive Protein (hsCRP)
HIV Genotyping & Phenotyping
HIV Tropism 
Laboratory Testing
HLA-B*15:02 Genetic Testing
HLA-DQB1*06:02 Testing for Narcolepsy
Human Leukocyte Antigen (HLA) Testing for Celiac Disease
Homocysteine Metabolism-Related Testing
FloridaBlue
FloridaBlue
FloridaBlue
Human Papillomavirus (HPV) Testing
Identification of Microorganisms Using Nucleic Acid Probes
Inflammatory Bowel Disease 
Testing
Influenza 
Diagnostic
Testing
Inherited Cardiomyopathies  & Channelopathies Genetic Testing
Inherited Peripheral Neuropathies Genetic Testing
Ionized
Calcium 
Testing
Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer
FloridaBlue
Cigna
Janus Kinase 2 (JAK2) V617F Gene Mutation Assay
Li-Fraumeni Syndrome Genetic Testing
KRAS, NRAS, & BRAF Variant Analysis in Metastatic Colorectal Cancer
K-ras Testing Required Before Epidermal Growth Factor Receptor Antibody Use in Colorectal Cancer
Analysis of KRAS Status
FloridaBlue
Chronic lymphoid leukemia (CLL) 
Biomarkers for Oncology
Hairy Cell Leukemia  
Biomarkers for Oncology
Acute lymphoid leukemia (ALL) 
Biomarkers for Oncology
MDS FISH
Marfan Syndrome Testing
MGMT Promoter Methylation Analysis
Mitochondrial Disorders Genetic Testing
Molecular RBC Phenotyping
Heavy Metal Testing
Myopathy 
Testing
Aetna
Molecular Syndromic Panels for Infectious Disease Pathogen Identification
Molecular Marker Evaluation of Thyroid Nodules
Anthem
Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer
Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels
myPath Melanoma Assay
Neuromuscular Disorders Genetic Testing
UHC
Neurofibromatosis &  Related Disorders Genetic Testing
Neurodegenerative Disorders Genetic Testing
NRAS Genetic Testing
Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA
FloridaBlue
Molecular Oncology Testing for Cancer Diagnosis, Prognosis, & Treatment Decisions
UHC
Oncotype DX Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
Oncotype DX Breast Cancer for DCIS
Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)
Pathogen Panel Testing
Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing
Parathormone (Parathyroid Hormone)
Pharmaco-genetic Testing for Non-Cancer Indications
Pharmaco-genomics Testing for FDA Known
Gene-Drug Interactions
Prescription Medication & Illicit Drug Testing in the Outpatient Setting
Pharmaco-genetic & Pharmaco-dynamic Testing
Aetna
Anthem
UHC
Cigna
Cigna
Medicare
Medicaid
Prostate Cancer Screening 
(Commercial)
Medicare
Percepta Bronchial Genomic Classifier
Preimplantation Genetic Diagnosis Testing
UHC
Prenatal Genetic & Chromosomal Metabolic Testing
Prolaris Prostate Cancer Genomic Assay
Prolaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
ProMark Risk Score
Myeloproliferative Neoplasms 
Mutation Analysis
Prenatal Testing using cell-free DNA
Anthem
Quantitative Drug Testing
Rheumatoid Arthritis 
Anti-CCP Testing
RET Proto-Oncogene Testing
Aetna
Rheumatic Diseases 
Testing
Respiratory Viral Panel Testing in the Outpatient Setting
Anthem
Rett Syndrome Genetic Testing
FloridaBlue
Measurement of Serum 1,25-dihydroxy- vitamin D
Serum Phosphorus
Somatic Genomic Testing
Serum Tumor Markers for Breast & Gastro-intestinal Malignancies
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Serologic (Antibody) Testing
Serum Iron Testing
Anthem
Serologic Diagnosis of Celiac Disease
Anthem
Sedimentation Rate - Erythrocyte
FloridaBlue
FloridaBlue
FloridaBlue
Humana
Susceptibility Studies
Syphilis Test
Sweat Test
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Viral (Antigen or Molecular) Testing
Somatic Tumor Testing
Humana
Anthem
Metabolite Markers of Thiopurines Testing
Total Calcium
TP53 Mutations  
Genetic Testing
Thyroid Testing
Anthem
Alpha-
& Beta-Thalassemia Genetic Testing
Targeted Phototherapy & Psoralen with Ultraviolet A for Vitiligo
Anthem
Tumor Genetic Markers
Tropism Testing for HIV Management
Troponin
Anthem
FloridaBlue
Urinary Tumor Markers for Bladder Cancer
Urinary Tract: 
Biomarkers for Oncology
Uterus/Ovary/ Fallopian Tube/Peritoneum:
Biomarkers for Oncology
Urine Culture
Anthem
Umbilical Cord Blood Testing & Storage
Urinalysis
Vitamin D; 25 hydroxy, includes fraction(s)
Vitamin D Assay Testing
Diagnostic Testing for the Evaluation of Vaginitis
Laboratory Evaluation
Vitamin B 12
Anthem
Cigna
Humana
Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, & Molecular Profiling
Anthem
Xpresys Lung Test
Zika Virus Risk Assessment

Indicates Non-covered Service

Antipro-thrombin Antibody Testing
Antigen Leukocyte Antibody Test
Bone Turnover Markers for Osteoporosis & Diseases With High Bone Turnover
Bronchial Gene Expression Classification for the Diagnostic Evaluation of Lung Cancer
Biomarker & Disease Activity Testing for Rheumatoid Arthritis
Advanced Lipoprotein Testing
Analysis of Proteomic Patterns
Anthem
FloridaBlue
FloridaBlue
FloridaBlue
FloridaBlue
Anthem
End-Tidal Carbon Monoxide Measurement (ETCOc)
Detection of Circulating Tumor Cells in the Blood as a Prognostic Factor for Cancer
Helicobacter Pylori Serology Testing
Hematopoietic Cell Transplantation for Breast Cancer
Fecal Analysis in the Diagnosis of Intestinal Disorders
Cell-free DNA Testing to Aid in the Monitoring of Kidney Transplants for Rejection
Anthem
FloridaBlue
FloridaBlue
FloridaBlue
Cigna
Anthem
Chemoresistance & Chemosensitivity Assays
FloridaBlue
Anthem
Intracellular Micronutrient Analysis
Laboratory Test-  Chronic Heart Failure & Heart Transplant Rejection
Machine Learning Derived Probability Score for Rapid Kidney Function Decline
In Vitro Chemosensi-tivity Assays & In Vitro Chemore-sistance Assays
Homocysteine Testing Cardiovascular Disease & Venous Thrombo-embolic Disease
FloridaBlue
FloridaBlue
Anthem
FloridaBlue
Anthem
Immune Biomarker Tests for Cancer
Anthem
Concurrent DNA & RNA Genetic Testing
Humana
Gene Expression Profile Testing & Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer
FloridaBlue
Gene Expression Profiling for Prostate Cancer
Humana
MolDX: Corus CAD Assay
Adolescent Idiopathic Scoliosis - Genetic Testing
Alzheimer’s Disease - Genetic Testing
Anthem
FloridaBlue
Circulating Tumor DNA Panel Testing (Liquid Biopsy)
Anthem
MolDx: Testing for Lyme Disease & Other Vector Borne Illness
Humana
MolDX: Prometheus IBD sgi Diagnostic Policy
Gene Expression Profile Tests for Multiple Myeloma
Anthem
Gene Expression Profiling & Genomic Biomarker Tests for Prostate Cancer
Anthem
Gene Expression Profiling for Bladder Cancer
Anthem
Gene Expression Profiling for Cancers of Unknown Primary Site
Anthem
Gene Expression Profiling for Colorectal Cancer
Anthem
Gene Expression Profiling for Idiopathic Pulmonary Fibrosis
Anthem
Gene Expression Profiling for Risk Stratification of Inflammatory Bowel Disease (IBD) Severity
Anthem
Gene Expression Profiling of Melanomas
Anthem
Genetic Testing for Frontotemporal Dementia (FTD)
Anthem
Genetic Testing for Macular Degeneration
Anthem
Anthem
Genetic Testing for Statin-Induced Myopathy
Anthem
Genetic Testing to Confirm the Identity of Laboratory Specimens
Anthem
Lactase Insufficiency - Genetic Testing
Anthem
Metagenomic Sequencing for Infectious Disease in the Outpatient Setting
Anthem
Paired DNA & Messenger RNA (mRNA) Genetic Testing to Detect, Diagnose & Manage Cancer
Anthem
Genetic Testing for Inherited Peripheral Neuropathies
Immune Cell Function Assay
Anthem
Measurement of Apolipoprotein B (apo B) & Apolipoprotein E (apo E) in Risk Assessment & Management of Cardiovascular Disease
FloridaBlue
Measurement of Long-Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor
FloridaBlue
Measurement of Serum Antibodies to Selected Biologic Agents
FloridaBlue
Measurement of Serum Concentrations of Monoclonal Antibody Drugs and Antibodies to Monoclonal Antibody Drugs
Anthem
Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy
Anthem
Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, & Solid Pancreatic Lesions
Anthem
Multianalyte Assays with Algorithmic Analyses for Cancer Indications
Humana
Multianalyte Assays With Algorithmic Analyses for Predicting Risk of Type 2 Diabetes
Multi-biomarker Disease Activity Blood Tests for Rheumatoid Arthritis
FloridaBlue
Anthem
Multi-marker Serum-Testing Related to Ovarian Cancer
FloridaBlue
Multiplex Autoantigen Microarray Testing for Systemic Lupus Erythematosus
Anthem
Novel Biomarkers in Risk Assessment & Management of Cardiovascular Disease
Humana
Nutrient/
Nutritional Panel Testing
Proprietary Algorithms for Liver Fibrosis in the Evaluation & Monitoring of Chronic Liver Disease
Humana
Pooled Antibiotic Sensitivity Testing
Proteomic Testing for Systemic Therapy in Non-Small Cell Lung Cancer
Anthem
Anthem
Protein Biomarkers for the Screening, Detection & Management of Prostate Cancer
FloridaBlue
FloridaBlue
Anthem
Plasma-Based Proteomic Screening of Pulmonary Nodules
FloridaBlue
Proteogenomic Testing for the Evaluation of Malignancies
Anthem
Red Blood Cell Folic Acid Testing
Anthem
Rupture of Membranes Testing in Pregnancy
Anthem
Saliva-based Testing to Determine Drug-Metabolizer Status
Anthem
Screening for Vitamin D Deficiency in Average Risk Individuals
Anthem
Selected Blood, Serum & Cellular Allergy & Toxicity Tests
Anthem
SensiGene® Fetal RhD Genotyping Test
Anthem
Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS)
Anthem
Serological Antibody Testing For Helicobacter Pylori
Anthem
Serum Amylase Testing
Anthem
Serum Antibodies for the Diagnosis of Inflammatory Bowel Disease
Serum Biomarker Human Epididymis Protein 4 (HE4)
Serum Biomarker Panel Testing for Systemic Lupus Erythematosus & Other Connective Tissue Diseases
FloridaBlue
FloridaBlue
FloridaBlue
Serum Biomarker Tests for Multiple Sclerosis
Anthem
Serum Biomarker Tests for Risk of Preeclampsia
Anthem
Serum Holotranscobalamin as a Marker of Vitamin B12 (Cobalamin) Status
Anthem
Spectral Analysis of Prostate Tissue by Fluorescence Spectroscopy
Anthem
Systems Pathology Testing for Prostate Cancer
Testing for Oral & Esophageal Cancer
FloridaBlue
FloridaBlue
Anthem
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