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Gene Expression Profiling for Uveal Melanoma
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Gene expression profiling for uveal melanoma with DecisionDx-UM is medically necessary for individuals with primary, localized uveal melanoma. Gene expression profiling for uveal melanoma that does not meet that criterion is investigational. To date, the U.S. Food and Drug Administration has chosen not to require any regulatory review of this test.
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What to do
Action · 5 steps
01Billing team: Bill gene expression profiling for uveal melanoma with DecisionDx-UM as medically necessary only for individuals with primary, localized uveal melanoma.
02Billing team: Gene expression profiling for uveal melanoma that does not meet that criterion is investigational.
03Billing team: The codes in the code reference are only medically necessary if the procedure is performed according to the Policy section, and the code reference lists CPT 81552, CPT 81599, and the diagnosis codes C69.30 through C69.32, C69.40 through C69.42, and C69.80 through C69.82.
04Billing team: Document the medical necessity of the service, because no payment is made for services not documented to be medically necessary, and a provider's order does not in itself make a service medically necessary.
05Billing team: Check the member's specific benefit plan language, because the coverage guidelines in the Medical Policy Manual should not be used in lieu of that language.
Codes mentioned
8155281599C69.30C69.32C69.40C69.42C69.80C69.82
Original notice
Gene Expression Profiling for Uveal Melanoma
bcbsms.com · Always check the source before changing claims.
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