CPT 81456 is referenced in 11 tracked payer policy changes from Blue Cross NC, Blue Cross Blue Shield of Rhode Island, and 6 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81456 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
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 Most changes involve updating billing systems with new procedure codes while removing outdated ones.
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'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.
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.
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.
Molecular testing for suspected myelofibrosis (MF) or essential thrombocythemia (ET) is medically necessary when the test is completed on blood or bone marrow, the patient presents with clinical, laboratory, or pathologic findings suggesting MF or ET, secondary causes have been evaluated, and a JAK2, MPL, or CALR mutation is tested for. Molecular testing for suspected polycythemia vera (PV) is medically necessary when the test is completed on blood or bone marrow, the patient presents with findings suggesting PV, evaluation for secondary causes has been completed, and the test is for JAK2 mutations. JAK2, MPL, and CALR testing is investigational in all other circumstances, including diagnosis of nonclassic myeloproliferative neoplasms and molecular phenotyping of patients with MPNs. Broad molecular panel testing is considered investigational.
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 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.
Humana Healthy Horizons in Ohio (Medicaid) has established a new policy covering comprehensive genomic profiling and molecular biomarker testing for cancer, including specific tests for hematologic malignancies and suspected myeloid disorders. The policy requires prior authorization for covered genomic testing services and outlines specific medical necessity criteria for approval.
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 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).
Watch 81456
Get one email when a payer policy names 81456, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
See every payer rule for 81456
Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 81456 in one place.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.