All PlansPrior AuthMedium impact
Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome
Regence BlueShield·Oncology, OB-GYN, Urology +2 more·Prior Authorization
Effective date
Jun 1, 2026
We identified it
Jun 16, 2026
Summary
New prior authorization policy for genetic testing related to hereditary breast, ovarian, pancreatic, and prostate cancer and Li-Fraumeni syndrome, effective June 1, 2026. The policy establishes specific medical necessity criteria and requires comprehensive documentation including family history, risk assessment tools, and clinical rationale before testing can be approved.
Action Required
Before June 1, 2026: Billing team must update prior authorization procedures for all genetic testing related to BRCA1/2, TP53, and other hereditary cancer genes (BRIP1, CDH1, PALB2, PTEN, RAD51C, RAD51D, STK11). Providers must document specific family history criteria, personal cancer history details, or use USPSTF-endorsed risk stratification tools. Update intake forms to capture required family history documentation and create checklist for genetic testing authorization requirements. Claims will be denied without proper documentation and prior authorization approval.