CommercialCoverageMedium impact
Carrier Screening for Genetic Diseases (2.04.107)
Blue Shield of California·CA · Genetics, OB-GYN, Family Medicine·Genetic Testing
Effective date
Mar 1, 2026
We identified it
Nov 1, 2025
Summary
Blue Shield of California updated their carrier screening policy for genetic diseases, establishing new medical necessity criteria for targeted and non-targeted genetic screening panels. The policy specifies coding requirements including CPT 81443 for panels with 15+ genes including CFTR and SMN1, and establishes that carrier screening is only medically necessary once per lifetime.
Action Required
Before March 1, 2026: Billing team must update genetic testing protocols to ensure carrier screening panels with 15+ genes that include CFTR and SMN1 are billed using CPT 81443. Review current genetic screening billing to ensure compliance with once-per-lifetime coverage limitation and update system edits to prevent duplicate billing. Verify all carrier screening meets new medical necessity criteria before submission.