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Medical & Coding Policies
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Out-of-State & Non-Network
Printer Friendly Version Non-BRCA Breast Cancer Risk Assessment
DESCRIPTIONThe OncoVue® Breast Cancer Risk Test (InterGenetics, Inc.) is a proprietary test for which the status of multiple single nucleotide polymorphisms (SNPs) is evaluated and the results incorporated along with personal history measures to determine breast cancer risk at different times during adulthood. The test does not detect known high risk genetic factors such as BRCA mutations (associated with hereditary breast and ovarian cancer, see Policy 2.04.02). OncoVue synthesizes the various risk measures into a personalized single risk estimate for premenopause, perimenopause, and postmenopause for each patient, with comparison to the average population risk at each of these life stages.For women without a strong family history of breast cancer and at average risk prior to testing, OncoVue purports to estimate a woman’s individual risk and place her in standard-, moderate-, or high-risk groups. The results are intended to help a woman and her physician decide if more frequent exams and/or more sophisticated surveillance techniques are indicated. For women already known to be at high risk based on a family history consistent with hereditary breast cancer, the test is represented as having added value by indicating greater or lesser risk at different life stages. The OncoVue test is available only through the Breast Cancer Risk Testing Network (BCRTN), described as a network of Breast Care Centers engaged in frontline genetic identification of breast cancer risk levels in their patients. BCRTN members will provide genetic breast cancer risk testing for their patients using OncoVue as part of a comprehensive education program to help OncoVue “at-risk” women understand their risk level and intervention strategies. BCRTN members will be selected for the network, based on a number of criteria, including quality standards of care, level of breast cancer surveillance technology, and the capability of providing patient education on genetic testing and future risk management protocols. Genetic Testing for Hereditary Breast and/or Ovarian Cancer is addressed in a separate policy.
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POLICYThe OncoVue® Breast Cancer Risk Test is considered investigational as method of estimating individual patient risk for developing breast cancer.
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POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.As of publication of this policy, the OncoVue® has not been approved by the FDA. Per Intergentics's website they will be working with the FDA to assist them in understanding the complex nature of this technology.
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POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member’s specific benefit plan language.
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POLICY HISTORY10/13/2009: Policy added11/19/2009: Approved by MPAC 11/17/2010: Policy reviewed; no changes. 10/05/2011: Policy reviewed; no changes. 09/27/2012: Policy reviewed; no changes.
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SOURCESBlue Cross Blue Shield Association Policy # 2.04.57InterGenetics™ Incorporated (http://www.intergenetics.com/intergenetics/oncovue.html)
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CODE REFERENCEThis is not an all-inclusive list of non-covered procedure codes.All codes billed for this procedure are considered investigational and not eligible for coverage. Non-Covered CodesThere is no specific code for the OncoVue test.
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