All PlansCoverageMedium impact
Germline Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers (BRCA1, BRCA2, PALB2)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, OB-GYN, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a fresh medical policy (1 day old) establishing criteria for when germline genetic testing for BRCA1, BRCA2, and PALB2 variants may be considered medically necessary. The policy defines specific clinical circumstances for cancer-affected individuals and those with family history that would qualify for coverage of genetic testing.
Action Required
Immediately: Review current genetic testing orders and referrals to ensure they align with the new medical necessity criteria outlined in policy A.2.04.02. Billing team should verify that genetic testing requests for BRCA1, BRCA2, and PALB2 meet the specific clinical criteria before submission. Providers should document qualifying conditions (age at diagnosis, family history, cancer type, ethnicity) in patient records to support medical necessity.