Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Oncology, Urology, Pathology +1 moreMedium impact
Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
The 05/18/2026 update added MiCheck Prostate to the list of investigational biomarkers for prostate cancer and changed the description of laboratories certified under CLIA. The policy considers these diagnostic biomarker tests investigational: kallikrein markers (such as 4Kscore), Prostate Health Index (PHI), HOXC6 and DLX1 testing (such as SelectMDx), PCA3, ERG and SPDEF RNA expression in exosomes (such as ExoDx Prostate IntelliScore), autoantibody panels (such as Apifiny), PCA3 testing (such as Progensa PCA3 Assay), TMPRSS:ERG fusion genes (such as MyProstate Score), gene hypermethylation testing (such as ConfirmMDx), mitochondrial DNA variant testing (such as Prostate Core Mitomics Test), PanGIA Prostate, MiCheck Prostate, and candidate gene panels. Single nucleotide variant testing for cancer risk assessment of prostate cancer is also investigational.
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01Billing team: Treat the listed biomarker tests as investigational when billing for diagnosis of prostate cancer, because the policy defines investigative services as not considered medically necessary.
02Include MiCheck Prostate, added to the investigational list on 05/18/2026, in that check.
03Single nucleotide variant testing for cancer risk assessment of prostate cancer is also investigational.
Codes mentioned
81229813138147981539815428155184999
Original notice
Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
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