Bioimpedance Devices for Detection and Management of Breast Cancer Related Lymphedema 2.01.52
Summary
Excellus BlueCross BlueShield policy 2.01.52 says bioimpedance spectroscopy (BIS) may be considered medically necessary for diagnosis or surveillance of subclinical breast cancer-related lymphedema when all required criteria are met. The criteria require a history of breast cancer treatment with at least one listed factor, such as axillary lymph node dissection, sentinel lymph node biopsy with more than six nodes removed, regional node irradiation, taxane-based chemotherapy, sentinel lymph node biopsy with BMI greater than 30 kg/m2, or mastectomy in the setting of invasive breast cancer. BIS is considered investigational for all other indications. The January 22, 2026 off-cycle update added this statement and changed the policy title.
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