CommercialCoverageMedium impact
Genetic Cancer Susceptibility Panels Using Next Generation Sequencing (2.04.93)
Blue Shield of California·CA · Genetics, Oncology, Family Medicine +1 more·Genetic Testing
Effective date
Apr 1, 2026
We identified it
Apr 1, 2026
Summary
Blue Shield of California updated their genetic cancer susceptibility panel testing policy, establishing specific criteria for when multigene panel testing is considered medically necessary versus investigational. The policy defines 'limited' panels (including only relevant gene variants for specific cancer indications) as potentially covered when criteria are met, while 'expanded' panels (including variants beyond Table PG1 or not recommended for the specific cancer type) are generally considered investigational.
Action Required
Before April 1, 2026: Billing team must review genetic testing claims to ensure they meet the specific criteria outlined in Policy 2.04.93. Update prior authorization processes to verify that multigene panels include only gene variants listed in Table PG1 for the specific cancer indication. Train staff to identify when expanded panels may be denied as investigational. Review existing genetic testing orders to ensure compliance with the new limited panel requirements.