CommercialCoverageMedium impact
Immunohistochemistry for Microscopic Evaluation of Prostate Biopsy
Blue Cross & Blue Shield of Mississippi·MS · Pathology, Urology, Oncology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their immunohistochemistry (IHC) staining policy for prostate biopsy evaluation, clarifying when IHC testing is medically necessary versus not reasonable and necessary. The policy specifies that IHC is only covered for suspicious but non-diagnostic H&E stains and certain specific clinical scenarios, while prohibiting routine or reflex IHC testing without pathologist review.
Action Required
Immediately: Pathology and urology billing teams must ensure IHC testing for prostate biopsies is only billed when H&E stains are suspicious but not diagnostic, or for specific indications listed in the policy. Stop billing for routine IHC testing on morphologically negative cores or when performed as reflex orders before pathologist H&E review. Update billing protocols to require pathologist documentation of medical necessity before processing IHC claims.