Blue Shield of CaliforniaCommercial · Administrative · Medical Policy · CA · Oncology, PathologyMedium impact
Gene Expression Profile Testing and Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer (2.04.61)
Effective date
Nov 1, 2026
Identified
Nov 1, 2025
Summary
Blue Shield of California considers gene expression profile (GEP) and circulating tumor DNA (ctDNA) assays for determining the prognosis of stage II or III colon cancer following surgery investigational. Medicare National and Local Coverage Determinations may also apply for members in health plans subject to the Biomarker Testing Law, and LCD selection depends on the location of the servicing laboratory. Oncotype DX Colon Cancer (81525) has a positive MolDx coverage determination for stage II patients considering adjuvant chemotherapy after definitive surgery, while GeneFx Colon and Colvera ctDNA tests are not registered in the MolDx DEX Diagnostics Exchange Registry.
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01Already effective November 1, 2026: Check the policy's investigational statement before billing gene expression profile or ctDNA testing for stage II or III colon cancer recurrence.
02For Medicare, follow the Medicare National and Local Coverage section, since LCD selection depends on where the servicing laboratory is located.
03For Oncotype DX Colon Cancer (81525), confirm the patient is stage II and is considering adjuvant chemotherapy after definitive surgery, the population with the positive MolDx coverage determination, and note that GeneFx Colon and Colvera ctDNA are not registered in the MolDx DEX Diagnostics Exchange Registry.
04Direct questions about whether this policy applies to the Prior Authorization Department at (800) 541-6652.
05The annual review effective November 1, 2026 made no change to the policy statement.
Codes mentioned
81525
Original notice
Gene Expression Profile Testing and Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer (2.04.61)
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