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Blue Shield of CaliforniaAll Plans · Coverage · Medical Policy · CA · Dermatology, Oncology, PathologyHigh impact

Gene Expression Profiling for Cutaneous Melanoma (2.04.146)

Effective date
Sep 1, 2026
Identified
Nov 1, 2025

Summary

Blue Shield of California's medical policy 2.04.146 considers gene expression testing for cutaneous melanoma investigational, including the Pigmented Lesion Assay for suspicious pigmented lesions, myPath Melanoma for melanocytic lesions with indeterminate histopathologic features, DecisionDx-Melanoma for all indications, and the Merlin test (CP-GEP). The policy statement adds the Merlin test to this list, and the policy's effective date is September 1, 2026. The policy states that the evidence is insufficient to determine that these technologies improve the net health outcome.

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What to do

Action · 6 steps
01Already effective September 1, 2026: Check the current applicability of this policy.
02Billing team: refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services, because benefit determinations are based on the member health services contract language.
03For members enrolled in health plans subject to the Biomarker Testing Law, check the CMS Local Coverage Determination references in the policy (MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma and MolDX: Melanoma Risk Stratification Molecular Testing), since an LCD may also apply.
04Documentation for clinical review: no records are required.
05The coding table lists 0578U, 0089U, 0090U and 81529, and the policy states that listing a code does not imply member coverage.
06Questions about applicability go to the Prior Authorization Department at (800) 541-6652.

Codes mentioned

81529

Original notice

Gene Expression Profiling for Cutaneous Melanoma (2.04.146)
blueshieldca.com · Always check the source before changing claims.
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Related policy hubs

Blue Shield of California policiesCA policy changesDermatologyOncologyPathologyCode 81529

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