CommercialCoverageMedium impact
Laboratory Testing for the Screening and Management of Prostate Cancer 2.02.48
Excellus BlueCross BlueShield·Urology, Oncology, Internal Medicine +1 more·Genetic Disease (Inherited Disease)
Effective date
Sep 18, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their prostate cancer laboratory testing policy effective September 18, 2025. Most biomarker screening tests are now considered investigational and will not be covered, while specific gene expression tests (Oncotype DX GPS, ProMark, Prolaris, Decipher) are covered only for post-diagnosis management under strict criteria.
Action Required
By September 18, 2025: Billing team must update systems to flag prostate cancer biomarker screening tests (PCA3, 4Kscore, PHI, ConfirmMDx, SelectMDx, ExoDx, etc.) as investigational and not covered for Excellus BCBS members. For post-diagnosis gene expression tests (Oncotype DX GPS, ProMark, Prolaris, Decipher), verify patient meets ALL criteria: initial risk stratification, 10+ year life expectancy, and appropriate risk group classification. Update prior authorization workflows to include risk group verification. Claims for investigational tests will be denied.