CommercialCoverageMedium impact
Germline Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers (BRCA1, BRCA2, PALB2) (2.04.02)
Blue Shield of California·CA · Genetics, Oncology, OB-GYN +2 more·Genetic Testing
Effective date
May 1, 2026
We identified it
Nov 1, 2025
Summary
Blue Shield of California updated their genetic testing policy for BRCA1, BRCA2, and PALB2 variants, expanding criteria for medically necessary testing in both cancer-affected and unaffected individuals. The policy provides detailed eligibility requirements based on personal/family history, age at diagnosis, cancer type, and ancestry.
Action Required
Before May 1, 2026: Billing and prior authorization teams must review and update criteria for genetic testing requests for BRCA1, BRCA2, and PALB2. Update internal guidelines to reflect new age thresholds, family history requirements, and expanded coverage for unaffected individuals with >5% probability scores. Train staff on new eligibility criteria to ensure proper prior authorization submissions and reduce denials.