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Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Blue Cross and Blue Shield Association policy 2.04.115 states that the use of comprehensive genomic profiling for selecting targeted cancer treatment is investigational. The policy focuses on expanded molecular panels that test many genetic markers without regard to whether a specific targeted treatment has demonstrated benefit, and it does not address testing for individual variants with established utility. The code reference lists investigational CPT codes, including 0643U (New 07/01/2026) and 0696U (New 10/01/2026).
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What to do
Action · 3 steps
01REQUIREMENTS: Billing team: Do not bill comprehensive genomic profiling for selecting targeted cancer treatment as a covered service, because the policy considers its use investigational and not medically necessary.
02Billing team: Review the Member's specific benefit plan language before billing any code in the code reference, because the Medical Policy Manual coverage guidelines should not be used in lieu of that language.
03Billing team: Check the code reference for the investigational codes 0643U (New 07/01/2026) and 0696U (New 10/01/2026) when setting up charge entry for these services.
Codes mentioned
81175811768121981272812738131481449814518145681479815358153681538
Original notice
Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies
bcbsms.com · Always check the source before changing claims.
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