All PlansCoverageMedium impact
Germline Genetic Testing for Gene Variants Associated With Breast Cancer in Individuals at High Breast Cancer Risk (CHEK2, ATM, and BARD1)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, OB-GYN, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
New policy establishes coverage criteria for germline genetic testing of CHEK2, ATM, and BARD1 gene variants for individuals at high breast cancer risk. This affects genetic testing billing for patients with moderate-penetrance breast cancer susceptibility genes.
Action Required
Immediately: Review current genetic testing workflows to ensure proper documentation of high breast cancer risk criteria for CHEK2, ATM, and BARD1 testing. Billing team should verify that genetic testing claims include appropriate medical necessity documentation showing patient meets high-risk criteria. Update encounter forms and EMR templates to capture family history and risk assessment documentation required for coverage determination.