CommercialCoverageMedium impact
Molecular Marker Testing of the Thyroid 2.02.49
Excellus BlueCross BlueShield·Endocrinology, General Surgery, Oncology +1 more·Genetic Disease (Inherited Disease)
Effective date
Nov 20, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new coverage criteria for molecular marker testing of thyroid nodules, effective November 20, 2025. The policy defines specific tests like Afirma Genomic Sequencing Classifier and ThyroSeq as medically necessary only when strict criteria are met, including indeterminate cytologic findings and impact on surgical decision-making.
Action Required
By November 20, 2025: Billing team must implement coverage criteria verification for thyroid molecular marker testing. Ensure prior authorization requests include documentation of indeterminate cytologic findings (Bethesda category III, IV, or V), absence of strong clinical/radiologic malignancy findings, and confirmation that surgical decision-making would be affected by test results. Update pre-authorization checklists to include these specific requirements.