Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Non-Small-Cell Lung Cancer (EGFR, ALK, BRAF, ROS1, RET, MET, KRAS, NTRK) (2.04.45)
Summary
Blue Shield of California Medical Policy 2.04.45 sets criteria for somatic biomarker testing in advanced or metastatic non-small-cell lung cancer (NSCLC) for EGFR, ALK, BRAF, ROS1, RET, MET, KRAS and NTRK variants, to select targeted therapy. Tissue testing may be considered medically necessary when the individual has no FDA-labeled contraindication to the requested agent and the agent is used consistently with its FDA-approved label, and plasma testing may be considered as an alternative to tissue biopsy for EGFR, ALK, KRAS, MET exon 14 skipping and NTRK when an FDA-approved companion diagnostic plasma test is used, while plasma testing for BRAF V600E, ROS1 and RET is considered investigational. The February 1, 2026 update was administrative, and the policy statement has no changes from the previous version.
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