CommercialCoverageMedium impact
Germline Genetic Testing for Hereditary Cancers 2.02.60
Excellus BlueCross BlueShield·Oncology, Hematology, OB-GYN +4 more·Genetic Disease (Inherited Disease)
Effective date
Apr 16, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their policy for germline genetic testing for hereditary cancers, establishing specific medical necessity criteria for genetic testing coverage across multiple cancer types including breast, ovarian, pancreatic, prostate, and colorectal cancers. The policy defines when multigene panel testing is appropriate and lists specific circumstances that are considered not medically necessary.
Action Required
Before April 16, 2026: Billing team must review and update genetic testing authorization processes to align with new medical necessity criteria. Providers must ensure documentation meets specific criteria outlined in Policy Statement VI for breast, ovarian, pancreatic, prostate, and other hereditary cancer genetic testing. Update prior authorization workflows to verify patient meets appropriate testing criteria before submitting genetic testing claims to avoid denials.