Genetic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Advanced Cancer (2.04.151)
Summary
Blue Shield of California policy 2.04.151 sets the criteria for genetic biomarker testing on tumor tissue or circulating tumor DNA (liquid biopsy) to select FDA-approved targeted cancer treatments, and the current version took effect June 1, 2026. Each listed test, such as ALK, BRAF, BRCA1 and BRCA2, EGFR, KRAS, PIK3CA, PD-L1 and tumor mutational burden, may be considered medically necessary when all of its listed criteria are met, and other uses are considered investigational. California laws cited in the policy prohibit health plans from requiring prior authorization for biomarker testing for stage 3 or 4 advanced or metastatic cancer and for cancer progression or recurrence.
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