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Miscellaneous Genetic and Molecular Diagnostic Tests
Blue Cross & Blue Shield of Mississippi·MS · Gastroenterology, Family Medicine, Internal Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS updated their medical policy on miscellaneous genetic and molecular diagnostic tests, clarifying coverage determinations for various genetic tests including Prometheus Celiac PLUS, Crohn's Prognostic, DNA Methylation Pathway Profile, and IBD diagnostic tests. The policy indicates insufficient evidence for clinical utility of these tests, which typically means non-coverage or denial of claims.
Action Required
Immediately: Review current genetic and molecular diagnostic test claims to identify any tests listed in this policy (Prometheus Celiac PLUS, Crohn's Prognostic, DNA Methylation Pathway Profile, GI Effects Stool, IBD sgi Diagnostic, know error, Monitr Crohn's Disease Test). Billing team should verify coverage with BCBS before submitting claims for these tests as they may be considered investigational and denied. Update prior authorization workflows to flag these specific genetic tests for coverage verification.