Blue Cross & Blue Shield of MississippiAll Plans · Billing Codes · Medical Policy · Genetics, OncologyMedium impact
Genetic Testing for Li-Fraumeni Syndrome
Effective date
Oct 1, 2026
Identified
Jun 20, 2026
Summary
Genetic testing for TP53 may be considered medically necessary to confirm Li-Fraumeni syndrome in individuals who meet the classic or Chompret clinical diagnostic criteria, in individuals with early-onset breast cancer (age of diagnosis under 31 years), or in pediatric hypodiploid acute lymphoblastic leukemia. Targeted TP53 familial variant testing may be considered medically necessary in an at-risk relative of a proband with a known TP53 pathogenic variant, and genetic testing for a germline TP53 variant is investigational for all other indications. Effective 2026-10-01, the code reference was updated to remove an ICD-9 diagnosis code and add ICD-10 diagnosis codes QA1.790, QA1.791 and QA1.792.
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01Already effective 2026-10-01: Billing team: confirm that ICD-10 diagnosis codes QA1.790, QA1.791 and QA1.792 are set up in charge entry for TP53 genetic testing, because the policy lists them as new codes effective that date, and check current applicability of these codes at the source link.
02Bill TP53 gene analysis (CPT 81351 full gene sequence, CPT 81352 targeted sequence analysis, or CPT 81353 known familial variant) only when the record documents one of the listed indications: meeting the classic or Chompret criteria, early-onset breast cancer under age 31, pediatric hypodiploid acute lymphoblastic leukemia, or targeted familial variant testing for an at-risk relative of a proband with a known TP53 pathogenic variant.
03BCBSMS makes no payment for services not documented to be medically necessary, and a provider's order does not by itself make a service medically necessary.
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