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Next-Generation Sequencing for the Assessment of Measurable Residual Disease
Effective date
Oct 1, 2026
Identified
Jun 20, 2026
Summary
Next-generation sequencing (NGS) to detect measurable residual disease (MRD), such as clonoSEQ, may be considered medically necessary as an alternative test at a threshold of 10-4 for acute lymphoblastic leukemia and chronic lymphocytic leukemia, and at a threshold of 10-5 for multiple myeloma. NGS for MRD at thresholds below those levels is investigational, and it is investigational for diffuse large B-cell lymphoma, mantle cell lymphoma and all other situations. Already effective 10/01/2026, CPT code 0688U, NGS of circulating tumor DNA for MRD in colorectal cancer, was added as an investigational code.
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What to do
Action · 4 steps
01Already effective 10/01/2026: Billing team: Treat CPT 0688U as an investigational code, since it is listed under Investigational Codes for NGS of circulating tumor DNA for MRD in colorectal cancer.
02For MRD testing with NGS (such as clonoSEQ), bill for individuals with acute lymphoblastic leukemia or chronic lymphocytic leukemia only at a threshold of 10-4, and for multiple myeloma only at a threshold of 10-5, because those are the thresholds the policy considers medically necessary as an alternative test.
03Thresholds below 10-4 for ALL or CLL, below 10-5 for multiple myeloma, and MRD testing for diffuse large B-cell lymphoma, mantle cell lymphoma or any other situation are investigational under this policy.
04The policy states that BCBSMS makes no payment for services not documented to be medically necessary, and that medically necessary codes are only medically necessary when the procedure is performed according to the Policy section.
Codes mentioned
8147981599C81.7AC88.91C90.00C90.02C91.00C91.02C91.10C91.12
Original notice
Next-Generation Sequencing for the Assessment of Measurable Residual Disease
bcbsms.com · Always check the source before changing claims.
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