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