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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

Laboratory

ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP)
4Kscore Test Medicare
Acute Myeloid Leukemia Genetic Testing
Allergy Testing
AlloSure Donor-Derived Cell-Free DNA Test
Alpha-1 Antitrypsin Deficiency Testing
Alpha-Fetoprotein Testing -
Outpatient
FloridaBlue
Aetna
Anthem
APC &  MUTYH Gene Testing
Atherosclerotic Cardiovascular Disease Risk Assessment
Cigna
Aetna
BCR-ABL1 Testing in Chronic Myelogenous Leukemia & Acute Lymphoblastic Leukemia
BCR-ABL Negative Myeloproliferative Disease 
Genetic Testing
BDX-XL2 Assay
Medicare
BRAF Mutation Analysis
Brain Natriuretic Peptide (BNP)
BRCA1 & BRCA2 Genetic Testing
Anthem
Assays of Genetic Expression in Tumor Tissue to Determine Prognosis in Patients with Breast Cancer
FloridaBlue
Breast Cancer Assay: Prosigna
Gene Expression Profiling for Managing Breast Cancer Treatment
Anthem
B-Type Natriuretic Peptide (BNP)
FloridaBlue
CADASIL Syndrome Genetic Testing
Cancer Susceptibility and Management Gene Mutation Testing for Solid Tumor Cancer
Anthem
Cardiac Disease 
Genetic Testing
UHC
Cardiac Ion Channel Genetic Testing
Hereditary Cardiomyopathie s
 (including ARVD/C)
Genetic Testing for Diagnosis & Management
Cardiovascular Disease (CVD) Risk Testing
Humana
Carrier Screening in the Prenatal Setting & Preimplantation Genetic Testing
Anthem
Chromosome 1p/19q Deletion Analysis
Comprehensive Genetic Testing
MA
Cystatin C Measurement
Decipher Biopsy Prostate Cancer Classifier Assay for Men with Very Low & Low Risk Disease
Carrier Testing for Genetic Diseases
UHC
Chromosomal Microarray Analysis (CMA) for Developmental Delay, Autism Spectrum Disorder, Intellectual Disability & Congenital Anomalies
Anthem
ConfirmMDx Epigenetic Molecular Assay
Cystic Fibrosis Genetic Testing
DecisionDx-Melanoma
Catecholaminergic Polymorphic Ventricular Tachycardia Genetic Testing
Chromosome Microarray Testing (Non-Oncology Conditions)
UHC
Controlled Substance Monitoring & Drugs of Abuse Testing
DecisionDx-UM (Uveal Melanoma)
Celiac Disease Testing
Circulating Tumor DNA Panel Testing (Liquid Biopsy)
Anthem
COVID-19
In Vitro Diagnostic Testing
Aetna
DNA Analysis of Stool to Screen for Colorectal Cancer
Cell-free DNA Testing for the Management of Cancer
Anthem
Colorectal Cancer: 
Biomarkers for Oncology
FloridaBlue
Cutaneous Malignant Melanoma-
Genetic Testing
Drug Testing
Aetna
Cell-free Fetal DNA Testing
UHC
Comparative Genomic Hybridization (CGH) - Chromosomal Microarray Analysis (CMA) for Selected Hereditary Conditions
CYP2C19, CYP2D6, CYP2C9, & VKORC1 Genetic Testing
Drug Testing in Pain Management & Substance Use Disorder Treatment
Aetna
FloridaBlue
CHARGE Syndrome Genetic Testing
Anthem
Outpatient Testing for Drugs of Abuse
Ehlers-Danlos Syndrome 
Genetic Testing
Fanconi Anemia Genetic Testing
Folate Testing
Duchenne, Becker, Facioscapulohumeral, & Limb-Girdle Muscular Dystrophies Genetic Testing
Endocrine Gland Cancer Susceptibility 
Genetic Testing
Fecal Calprotectin Testing
FloridaBlue
UHC
EndoPredict Breast Cancer Gene Expression Test
Fetal Fibronectin Enzyme Immunoassay
FloridaBlue
Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test
Flow Cytometry
Aetna
Epilepsy Genetic Testing
Flow cytometry: Cell cycle or DNA analysis
Erythrocyte Sedimentation Rate
Flow cytometry: Cell surface, cytoplasmic, or nuclear marker
FMR1 mutations (including Fragile X Syndrome) Genetic Testing
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)
Genetic Testing for Inherited Diseases
Anthem
Genotype Testing for Individual Genetic Polymorphisms to Determine Drug Metabolizer Status
Anthem
HbA1c
Hepatitis B Surface Antigen
High Sensitivity C-Reactive Protein (hsCRP)
FloridaBlue
Human Papillomavirus (HPV) Testing
Identification of Microorganisms Using Nucleic Acid Probes
FloridaBlue
Ionized
Calcium 
Testing
Janus Kinase 2 (JAK2) V617F Gene Mutation Assay
KRAS, NRAS, & BRAF Variant Analysis in Metastatic Colorectal Cancer
FloridaBlue
Li-Fraumeni Syndrome Genetic Testing
Gastrointestinal Pathogen Panel (GIPP) Testing for Infectious Diarrhea in the Outpatient Setting
Anthem
Genetic Testing for Neurode-generative Disorders
Germline Mutations of the RET Proto-Oncogene Genetic Testing
Heavy Metal Testing
Hereditary Cancer Testing
Anthem
HIV Genotyping & Phenotyping
FloridaBlue
Inflammatory Bowel Disease 
Testing
Cigna
K-ras Testing Required Before Epidermal Growth Factor Receptor Antibody Use in Colorectal Cancer
GeneSight Assay for Refractory Depression
Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, & MTHFR)
Glioma Molecular Analysis
Helicobacter Pylori Infection Testing
Hereditary Hearing Loss Genetic Testing
HIV Tropism 
Laboratory Testing
FloridaBlue
Influenza 
Diagnostic
Testing
Analysis of KRAS Status
Genetic Testing
Aetna
Genetic Testing for Lynch Syndrome, Familial Adenomatous Polyposis (FAP), Attenuated FAP & MYH-associated Polyposis
Anthem
Outpatient Glycated Hemoglobin & Protein Testing 
(HbA1c)
Anthem
Hepatic (Liver) Function Panel
Hereditary Hemochromatosis Genetic Testing
HLA-B*15:02 Genetic Testing
Inherited Cardiomyopathies  & Channelopathies Genetic Testing
Genetic Testing for Breast, Ovarian and Pancreatic Cancer Susceptibility
Humana
Genetic Testing for Lynch Syndrome & Other Inherited Colon Cancer Syndromes
FloridaBlue
Guardant360 Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)
Hepatitis Screening
UHC
Hereditary Pancreatitis Genetic Testing
Homocysteine Metabolism-Related Testing
Inherited Peripheral Neuropathies Genetic Testing
Genetic Testing for Diagnosis and Monitoring of Cancer
Humana
Genetic Testing for TP53 Mutations
Anthem
Hepatitis B Surface Antibody
Heritable Cardiac Conditions 
Genetic Testing
Anthem
Human Leukocyte Antigen (HLA) Testing for Celiac Disease
Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer
Genetic Testing for Inherited Conditions
Anthem
Genitourinary Conditions 
Testing
Heterozygous Familial Hypercho-lesterolemia Genetic Testing
Marfan Syndrome Testing
MDS FISH
Measurable Residual Disease Assessment in Lymphoid Cancers Using Next Generation Sequencing
Heavy Metal Testing
MGMT Promoter Methylation Analysis
Mitochondrial Disorders Genetic Testing
Molecular RBC Phenotyping
Anthem
Molecular Syndromic Panels for Infectious Disease Pathogen Identification
Molecular Marker Evaluation of Thyroid Nodules
Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer
Molecular Oncology Testing for Cancer Diagnosis, Prognosis, & Treatment Decisions
Myeloproliferative Neoplasms 
Mutation Analysis
Myopathy 
Testing
Aetna
Anthem
UHC
myPath Melanoma Assay
Neurodegenerative Disorders Genetic Testing
Neurofibromatosis &  Related Disorders Genetic Testing
Neuromuscular Disorders Genetic Testing
Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA
NRAS Genetic Testing
UHC
FloridaBlue
Oncologic Genetic Testing
Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)
Oncotype DX Breast Cancer for DCIS
Oncotype DX Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
MA
Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing
Pathogen Panel Testing
Percepta Bronchial Genomic Classifier
Pharmaco-genetic & Pharmaco-dynamic Testing
Pharmaco-genetic Testing for Non-Cancer Indications
Pharmaco-genomics Testing for FDA Known
Gene-Drug Interactions
Anthem
Aetna
Cigna
UHC
Medicare
Cigna
Preimplantation Genetic Diagnosis Testing
Prenatal Genetic & Chromosomal Metabolic Testing
Prenatal Genetic Testing
Prenatal Testing using cell-free DNA
Prescription Medication & Illicit Drug Testing in the Outpatient Setting
Prolaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
UHC
Anthem
Medicaid
ProMark Risk Score
Quantitative Drug Testing
Respiratory Viral Panel Testing in the Outpatient Setting
Anthem
Sedimentation Rate - Erythrocyte
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Viral (Antigen or Molecular) Testing
Humana
Syphilis Test
Alpha-
& Beta-Thalassemia Genetic Testing
Tropism Testing for HIV Management
Anthem
Umbilical Cord Blood Testing & Storage
Diagnostic Testing for the Evaluation of Vaginitis
Prostate Cancer Screening 
(Commercial)
Medicare
RET Proto-Oncogene Testing
Aetna
Serologic Diagnosis of Celiac Disease
FloridaBlue
Somatic Genomic Testing
Anthem
Targeted Phototherapy & Psoralen with Ultraviolet A for Vitiligo
Troponin
Urinalysis
Laboratory Evaluation
Vitamin B 12
Anthem
PTEN Hamartoma Tumor Syndrome Genetic Testing
Anthem
Rett Syndrome Genetic Testing
Measurement of Serum 1,25-dihydroxy- vitamin D
FloridaBlue
Somatic Tumor Testing
Anthem
Metabolite Markers of Thiopurines Testing
Tumor Genetic Markers
FloridaBlue
Urinary Tumor Markers for Bladder Cancer
Vitamin D Assay Testing
Cigna
Humana
Rheumatic Diseases 
Testing
Serum Iron Testing
Anthem
Susceptibility Studies
Thyroid Fine Needle Aspirate Molecular Markers
Urine Culture
Anthem
Rheumatoid Arthritis 
Anti-CCP Testing
FloridaBlue
Serum Tumor Markers for Breast & Gastro-intestinal Malignancies
FloridaBlue
Sweat Test
Thyroid Testing
Anthem
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Serologic (Antibody) Testing
Humana
Total Calcium
TP53 Mutations  
Genetic Testing
Anthem
Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, & Molecular Profiling
Anthem
Xpresys Lung Test
Zika Virus Risk Assessment

Indicates Non-covered Service

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