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Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Breast Cancer (BRCA1, BRCA2, PIK3CA, Ki-67, RET, BRAF, ESR1, NTRK)

Blue Cross & Blue Shield of Mississippi·MS · Oncology, OB-GYN, Internal Medicine +1 more·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

This is a new medical policy for biomarker testing in breast cancer, covering BRCA1/2, PIK3CA, Ki-67, RET, BRAF, ESR1, and NTRK testing including liquid biopsy. The policy establishes coverage criteria for genetic testing to guide targeted therapy decisions in breast cancer patients.

Action Required

Action needed
Immediately: Review new policy A.2.04.151 for biomarker testing in breast cancer. Billing team should verify coverage criteria for BRCA, PIK3CA, ESR1, and other biomarker tests before submitting claims. Ensure proper documentation of medical necessity aligns with policy requirements for genetic testing authorization.

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