Afirma Genomic Sequencing Classifier and ThyroSeq are considered medically necessary when indeterminate cytology (Bethesda category III or IV) is present, there are no strong clinical or radiologic findings suggestive of malignancy, and surgical decision making would be affected by the results. ThyroSeq, ThyraMIR microRNA/ThyGenX, Afirma BRAF and Afirma MTC are also considered medically necessary for Bethesda category III, IV or V cytology when malignancy must be determined and the results guide surgical planning for initial resection. RosettaGX Reveal, single-gene TERT testing, Thyroid GuidePx and Afirma Xpression Atlas are considered investigational. The 11/20/25 annual review made no changes to policy intent, although the policy statements were reformatted for clarity.
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01Already effective 2025-11-20: Billing team: Before billing a molecular marker test, confirm the Bethesda category on the fine needle aspirate and the criteria listed above, and check the codes in charge entry.
02Testing is appropriate once per lifetime per thyroid nodule.
03Code 81345 is marked E/I for thyroid carcinoma, code 0362U is marked E/I, and code 81479 is marked E/I for RosettaGX Reveal and Afirma Xpression Atlas testing.
04Coverage applies only to members with a valid contract, not to family members without one.
Codes mentioned
81345814458147981546C73D34D44.0
Original notice
Molecular Marker Testing of the Thyroid 2.02.49
excellusbcbs.com · Always check the source before changing claims.
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