Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Oncology, Pathology, PulmonologyMedium impact
Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Non-Small-Cell Lung Cancer (EGFR, ALK, BRAF, ROS1, RET, MET, KRAS, NTRK)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Somatic biomarker testing may be considered medically necessary in non-small-cell lung cancer to predict treatment response to FDA-approved targeted therapy for EGFR, ALK, BRAF V600E, ROS1, KRAS, RET, MET exon 14 skipping, and NTRK fusions when the individual meets the policy criteria. Plasma testing with an FDA-approved companion diagnostic plasma test may be considered medically necessary as an alternative to tissue biopsy for several of these genes, and for oncogenic driver variants when there is not sufficient tissue for standard molecular testing, with follow-up tissue-based analysis planned if no driver variant is found. Analysis of these genes in other situations, including plasma testing for BRAF V600E, ROS1 and RET, is considered investigational.
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01Billing team: Before billing these tests, confirm the individual has no FDA-labeled contraindications to the requested agent and that the agent is intended to be used consistently with its FDA-approved label, as the policy requires.
02Make sure the record documents that the service is Medically Necessary, because BCBSMS 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.
03For plasma testing when tissue is insufficient, document that the individual does not have sufficient tissue for standard molecular testing using formalin-fixed paraffin-embedded tissue and that follow-up tissue-based analysis is planned should no driver variant be identified via plasma testing.
04Treat all other uses listed in the policy as investigational.
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