CPT 81322 is referenced in 7 tracked payer policy changes from Capital Blue Cross, Regence BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81322 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Capital Blue Cross updated its medical policies, with most changes effective July 1, 2026 unless otherwise indicated. Prior authorization for Loargys and Exdensur now applies to J3590 and C9399 starting July 1, 2026, and the PA requirement for Exdensur moved from a 6/1 date to 7/1. Many revised medical injectable policies take effect August 1, 2026, and several policies remove procedure codes that will now be managed by EviCore.
Effective October 1, 2026, a genetic panel test is considered investigational when there is not enough research to show that its genes or variants can be used to manage treatment decisions and improve net health outcomes, and the entire panel is then considered investigational, with or without optional add-on genes. Named panels from laboratories such as Blueprint Genetics, GeneDx, Invitae and Labcorp are listed as investigational, and some of them are reviewed under other cross-referenced policies.
Genetic testing for BRCA1, BRCA2, BRIP1, CDH1, PALB2, PTEN, RAD51C, RAD51D, STK11, or TP53 may be considered medically necessary when the policy criteria are met, such as a known familial pathogenic variant, a personal history of breast, pancreatic, ovarian, fallopian tube, or peritoneal cancer, or documented increased risk based on one of seven USPSTF-endorsed risk-stratification tools. Testing for these genes for hereditary breast or ovarian cancer risk is investigational for individuals who do not meet the criteria, and single gene or panel testing for other genes, including ATM, BARD1, and CHEK2, is investigational for hereditary breast, ovarian, and/or prostate cancer. This policy is effective June 1, 2026.
Excellus BlueCross BlueShield policy 2.02.60 considers germline genetic testing for hereditary cancer medically appropriate in listed circumstances, including when a blood relative has a known pathogenic or likely pathogenic variant, when a pathogenic or likely pathogenic variant is found on tumor genomic testing, when results aid systemic therapy or surgical decisions, and when individuals meet specific criteria for breast, ovarian, pancreatic, prostate, colorectal, Cowden syndrome, Li-Fraumeni syndrome, hereditary diffuse gastric cancer or familial medullary thyroid carcinoma. Multigene panel testing is considered medically appropriate when an individual meets Policy Statement I, except Policy Statements I.A, I.D and I.G.9. The current effective date is April 16, 2026, and the annual update kept the policy intent unchanged.
Aetna considers endometrial biopsy medically necessary for the diagnostic evaluation of abnormal uterine bleeding in women suspected of having endometrial hyperplasia or endometrial carcinoma, and for endometrial cancer surveillance in women with Lynch syndrome. The endometrial brush (Tao brush) is an acceptable alternative to a suction curette such as the Pipelle for medically necessary sampling. Sentinel lymph node mapping is medically necessary for pathologic evaluation and surgical staging in persons with endometrial cancer and endometrial intraepithelial neoplasia (EIN), while endometrial biopsy for screening and many biomarker and genetic tests for endometrial cancer are experimental, investigational, or unproven.
Genetic testing for PTEN may be considered medically necessary to confirm a diagnosis when an individual has clinical signs of a PTEN hamartoma tumor syndrome. Targeted testing for a PTEN familial variant may be considered medically necessary in a first-degree relative of a proband with a known PTEN pathogenic variant, and all other genetic testing for PTEN is considered investigational. The 07/31/2026 update changed the policy description and removed ICD-9 diagnosis codes, and the policy statements are unchanged.
Aetna's clinical policy bulletin on endometrial cancer screening, diagnosis, and prognosis, CPB 0769, was reviewed on 2026-10-26. It states that endometrial biopsy for abnormal uterine bleeding and for Lynch syndrome surveillance is medically necessary, that the Tao brush is an acceptable alternative to a suction curette, and that sentinel lymph node mapping is medically necessary for endometrial cancer staging. It also lists many biomarker and screening tests as experimental, investigational, or unproven. The text does not state a new effective date or a specific change.
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