Medical Policy Subject: Genotyping Uridine Diphosphate Glycuronosyltransferase (ugt1a1) for Patients Treated with Irinotecan

PAGE: 1 OF: 5 • If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. • If a commercial product, including an Essential Plan product, covers a specific service, medical policy criteria apply to the benefit. • If a Medicare product covers a specific service, and there is no national or local Medicare coverage decision for the service, medical policy criteria apply to the benefit.