PAYER POLICY CHANGES

81449 Insurance Policy Changes

CPT 81449 is referenced in 10 tracked payer policy changes from Humana, Blue Cross NC, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81449 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Humana · Effective Sep 23, 2026High impact
Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - MICHIGAN (New)
Humana Medicaid Michigan has issued a new comprehensive policy (HUM-MI-2248-000) effective 09/23/2026 that establishes coverage criteria for genomic and molecular biomarker testing in cancer patients. The policy covers specific gene tests (BTK, CCND1::IGH, CEBPA, IDH1/IDH2, MYD88, NPM1, PIK3CA, PLCG2), multigene panels, liquid biopsies, and molecular pathology assays with defined medical necessity requirements for each test type. Billing teams must implement prior authorization requirements and ensure providers document specific cancer diagnoses and clinical indications matching the policy criteria.
Humana · Effective Sep 23, 2026High impact
Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - INDIANA (Revised)
Humana Indiana Medicaid updated its coverage policy for genomic and molecular biomarker testing for cancer, effective 09/23/2026. The policy specifies coverage criteria for multigene panel testing (CPT 81449), NPM1 gene testing (CPT 81310), molecular pathology testing (CPT 81479), and ThyroSeq v3 Genomic Classifier (CPT 0026U), while explicitly denying coverage for ThyroSeq v3 Cancer Risk Classifier (CPT 0287U) and multiple molecular marker assays for thyroid nodules. Billing teams must ensure claims align with the documented medical necessity criteria for each test type.
Blue Cross NC · Effective Jan 1, 2026High impact
Medical Policy Update December 31, 2025
Blue Cross NC updated multiple medical policies effective January 1, 2026, with extensive billing code changes including new CPT codes for IMRT procedures, archived spine-related policies, updated genetic testing codes, and new skin substitute codes. Most changes involve updating billing systems with new procedure codes while removing outdated ones.
Blue Cross Blue Shield of Rhode Island · Effective Aug 1, 2025High impact
Medical policy updates
Effective August 1, 2025, CPT codes 0118U, 0508U, 0509U, 0540U, 81595, 0016M and 0288U keep their prior authorization requirement, and their medical criteria move to the online authorization tool for participating providers for Medicare Advantage plans and commercial products. Effective September 1, 2025, prior authorization is removed for CPT 81455 and 81456 for Medicare Advantage plans and commercial products, and these services will be covered. Effective October 1, 2025, 76 additional ICD-10 diagnosis codes are covered for CPT 0077U for Medicare Advantage plans and commercial products, and CPT 20975 is corrected to require prior authorization for Medicare Advantage plans.
Blue Shield of California · Effective Nov 1, 2026Medium impact
Genetic Variant Testing (Including Liquid Biopsy) for Targeted Treatment in Advanced Cancer (2.04.151)
Blue Shield of California's medical policy 2.04.151, Genetic Variant Testing (Including Liquid Biopsy) for Targeted Treatment in Advanced Cancer, lists the tumor tissue and liquid biopsy tests it may consider medically necessary to select FDA-approved targeted treatments. The policy states an effective date of November 1, 2026, and its policy history for that date says the policy statement, guidelines and literature were updated, the title changed from Genetic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Advanced Cancer, and a coding update was made. The policy refers to Appendix A for the policy statement changes from the previous version.
Blue Shield of California · Effective Jul 1, 2026Medium impact
Comprehensive Genetic Profiling for Selecting Targeted Cancer Therapies (2.04.115)
Blue Shield of California medical policy 2.04.115 sets when comprehensive genetic profiling of tumor tissue can be used to select targeted cancer therapies. Broad molecular profiling may be considered medically necessary for individuals with recurrent, relapsed, refractory, metastatic, or advanced stage III or IV cancer when the test follows the policy's Table 1 parameters, and comprehensive genetic profiling for selecting targeted cancer treatment is considered investigational. The version effective July 1, 2026 includes an administrative update and a coding update, and the policy statement has no changes.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers 2.02.51
Excellus BlueCross BlueShield policy 2.02.51 considers molecular testing of tumor tissue medically appropriate to direct targeted therapy when the results will guide patient management and the test is for the listed cancers and genes, including metastatic colorectal cancer, non-small-cell lung cancer, stage III high-risk or stage IV melanoma, metastatic pancreatic cancer, recently diagnosed or recurrent ovarian cancer, metastatic prostate cancer, breast cancer, primary brain tumors, ependymomas, and medulloblastoma. For other cancers, testing must be recommended by current NCCN guidelines, include only the number of genes necessary for therapeutic decision making, and be used for biopsy-confirmed advanced stage III or IV or metastatic disease, or for such disease progressing after chemotherapy or immunotherapy when never previously tested. Comprehensive genomic profiling tests such as FoundationOne CDx are considered investigational, as is testing for genes other than those listed, and the version effective February 19, 2026 is an annual review with policy intent unchanged.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) 2.02.56
Excellus policy 2.02.56 Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) has a current effective date of February 19, 2026, and its 02/19/26 annual review states that policy intent is unchanged. Circulating tumor DNA analysis is considered medically appropriate only when it is used to direct targeted therapy, as an alternative to tissue biopsy when repeat invasive biopsy is contraindicated or there is not enough tissue, when the results will guide management, and when the test has FDA approval for the tumor type or disease site, and only for the listed cancers and gene targets. Liquid biopsy is investigational for all other indications, and comprehensive genomic profiling tests such as FoundationOne Liquid CDx and Guardant 360 are considered investigational.
BlueCross BlueShield of South Carolina · Effective Oct 1, 2025Medium impact
2025 August Medical Policy Updates
Effective 10/01/2025, Serum Tumor Markers for Malignancies (CAM 277) adds code 0599U, Genome and Exome Sequencing (CAM 291) adds codes 0582U and 0583U, Transplant Rejection Testing (CAM 329) adds code 0576U, and Microsatellite Instability and Tumor Mutational Burden Testing (CAM 342) revises code 0334U and adds code 0585U. Hepatitis Testing (CAM 127) adds coverage for individuals receiving immunosuppressant therapy and updates coverage criteria 8 to allow testing once every three months, and it adds HCPCS G0567. Pancreatic Enzyme Testing for Acute Pancreatitis (CAM 198) removes amylase from its criteria because amylase is no longer allowed for diagnosis of acute pancreatitis.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies
Blue Cross and Blue Shield Association policy 2.04.115 states that the use of comprehensive genomic profiling for selecting targeted cancer treatment is investigational. The policy focuses on expanded molecular panels that test many genetic markers without regard to whether a specific targeted treatment has demonstrated benefit, and it does not address testing for individual variants with established utility. The code reference lists investigational CPT codes, including 0643U (New 07/01/2026) and 0696U (New 10/01/2026).

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FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 81449?

Ambetter lists 81449 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for 81449?

AmeriHealth Caritas lists 81449 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 81449?

Anthem BCBS lists 81449 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 81449?

BCBS Illinois lists 81449 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

Does BCBS Montana require prior authorization for 81449?

BCBS Montana lists 81449 on 2026 Commercial Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 81449?

There are 10 tracked policy changes affecting CPT 81449, including updates from Humana, Blue Cross NC, Blue Cross Blue Shield of Rhode Island. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 81449?

Payers that have issued tracked updates for CPT 81449 include: Humana, Blue Cross NC, Blue Cross Blue Shield of Rhode Island, Blue Shield of California, Excellus BlueCross BlueShield, BlueCross BlueShield of South Carolina, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 81449 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 81449. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 81449?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - MICHIGAN (New)

Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - INDIANA (Revised)

Medical Policy Update December 31, 2025

Medical policy updates

Genetic Variant Testing (Including Liquid Biopsy) for Targeted Treatment in Advanced Cancer (2.04.151)

Comprehensive Genetic Profiling for Selecting Targeted Cancer Therapies (2.04.115)

Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers 2.02.51

Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) 2.02.56

2025 August Medical Policy Updates

Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies

Prior authorization required

Prior authorization required in some cases