CommercialCoverageMedium impact
Medical Policy Update for April 21, 2022
Blue Cross NC·NC · Oncology, Hematology, Pathology·Medical Policy
Effective date
Apr 21, 2022
We identified it
Jun 16, 2026
Summary
BCBSNC now covers tumor mutational burden (TMB) testing and microsatellite instability (MSI) testing for solid tumors when patients are being considered for Pembrolizumab (Keytruda) therapy. This is a new coverage policy that expands reimbursement for these genetic tests.
Action Required
Effective April 21, 2022: Billing team can now submit claims for TMB and MSI testing for solid tumor patients being considered for Pembrolizumab therapy to BCBSNC. Update billing guidelines to include this new covered service and ensure proper documentation links testing to Pembrolizumab consideration.