Technical Assessment Forms
Download Technical Assessment Forms (PDF)
| TA Form | Required Test |
|---|---|
|
GEN-CQD-003 |
All tests submitting a Technical Assessment |
|
GEN-PF-001 |
Tests with results that are either novel or proprietary technology and/or algorithms. Tests that require an evaluation of clinical utility or clinical validity that is not already established in existing policies or standards of care. |
|
NGS-PF-004 |
NGS “Targeted” Panel – Solid Tumor and Solid Tumor, plasma-based NGS “Comprehensive Genomic Profile” – Solid Tumor and Solid Tumor, plasma-based |
|
NGS-PF-005 |
NGS “Targeted" Panel – Hematopoietic Malignancy NGS “Comprehensive Genomic Profile” – Hematopoietic Malignancy UPDATED 04/17/2024 |
|
NGS-PF-006 |
Inherited Cancer Testing |
| NGS-PF-002 Analytical Validity – Performance Specifications for Comprehensive Genomic Profiling Checklist, Somatic and Germline |
NGS “Comprehensive Genomic Profile” – Solid Tumor and Solid Tumor, plasma-based NGS “Comprehensive Genomic Profile” – Hematopoietic Malignancy Whole Exome Sequencing Whole Genome Sequencing |
|
MRD-PF-016 |
Minimal Residual Disease (MRD) Testing |
|
MRS-PF-020 |
Molecular Testing for Risk Stratification (MRS) Example: Biomarkers |
|
MID-PF-019 |
Molecular Testing for Syndromic Infectious Disease (MID) |
|
PCFS-PF-021 Analytical Validity, Clinical Validation Summary Worksheet, PCFS |
Prenatal cell-free DNA Screening (PCFS) |
|
PCS-PF-022 Analytical Validity, Clinical Validation Summary Worksheet, PCS |
Prenatal Carrier Screening (PCS) |
|
PGX-PF-007 |
Pharmacogenomics (PGx) tests |
|
ALLO-CQ-003 |
Molecular Testing for Solid Organ Allograft Rejection |
|
ALLO-PF-009 |
Molecular Testing for Solid Organ Allograft Rejection |
|
GEN-PF-010 |
Required for tests that must be priced by Palmetto GBA |