All PlansCoverageMedium impact
Next-Generation Sequencing for the Assessment of Measurable Residual Disease
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Oncology·Medical Policy
We identified it
Jun 20, 2026
Summary
This new policy establishes coverage criteria for next-generation sequencing (clonoSEQ) to detect measurable residual disease in blood cancers. The test is considered medically necessary at specific sensitivity thresholds for acute lymphoblastic leukemia, chronic lymphocytic leukemia, and multiple myeloma, but remains investigational for other lymphomas and at higher sensitivity levels.
Action Required
Immediately: Review all clonoSEQ test orders to ensure they meet the specific sensitivity thresholds outlined in the policy. For acute lymphoblastic leukemia and chronic lymphocytic leukemia, only approve tests at 10-4 threshold. For multiple myeloma, only approve tests at 10-5 threshold. Flag any orders for diffuse large B-cell lymphoma or mantle cell lymphoma as investigational and likely to be denied. Billing team should verify medical necessity documentation matches the approved thresholds before submitting claims.