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Excellus BlueCross BlueShieldCommercial · Coverage · Lab Tests (pathology) · NY · Oncology, PathologyMedium impact

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

Effective date
Feb 19, 2026
Identified
Jun 20, 2026

Summary

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.

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What to do

Action · 5 steps
01Already effective February 19, 2026: Billing team: claims for circulating tumor DNA testing need documentation that the test is used for one of the listed cancers and gene targets, that the test has FDA approval for that tumor type, and that the results will guide management.
02Genetic testing is appropriate only when performed by a laboratory certified under the Clinical Laboratory Improvement Amendments (CLIA).
03Coverage applies only to members with a valid contract.
04Circulating tumor DNA testing should not be used in lieu of tissue diagnosis, and a liquid biopsy and a formalin-fixed paraffin-embedded tissue test should not be tested simultaneously.
05A negative liquid biopsy should be followed by reflex testing to a formalin-fixed paraffin-embedded tissue test.

Codes mentioned

8116281191811928119381194812108123581272812758127681277813078130981401814028140381404814058140681445814498145581456814628146381464814798615286153C61C78.5C79.81D40.0

Original notice

Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) 2.02.56
excellusbcbs.com · Always check the source before changing claims.
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Related changes

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Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers 2.02.51MediumEffective Feb 19, 2026 · Genetic Disease (Inherited Disease)Germline Genetic Testing for Hereditary Cancers 2.02.60MediumEffective Apr 16, 2026 · Genetic Disease (Inherited Disease)Genetic Testing for Thoracic Aortic Aneurysms/ Dissections and Connective Tissue Related Disorders 2.02.61MediumEffective Sep 17, 2026 · Genetic Disease (Inherited Disease)Genetic Testing for Thoracic Aortic Aneurysms/ Dissections and Connective Tissue Related Disorders 2.02.61MediumEffective Sep 17, 2026 · Genetic Disease (Inherited Disease)Browse every Excellus BlueCross BlueShield change in the policy list

Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesOncologyPathologyCode 81162Code 81191Code 81192Code 81193Code 81194Code 81210Code 81235Code 81272Code 81275Code 81276Code 81277Code 81307Code 81309Code 81401Code 81402Code 81403Code 81404Code 81405Code 81406Code 81445Code 81449Code 81455Code 81456Code 81462Code 81463Code 81464Code 81479Code 86152Code 86153Code C61Code C78.5Code C79.81Code D40.0

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