CommercialCoverageMedium impact
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)
Blue Shield of California·CA · Oncology, Pulmonology, Pathology·Medical Policy
Effective date
Feb 1, 2026
We identified it
Nov 1, 2025
Summary
Blue Shield of California updated their somatic biomarker testing policy for non-small-cell lung cancer, establishing coverage criteria for EGFR, ALK, BRAF, ROS1, RET, MET, KRAS, and NTRK testing including liquid biopsy options. The policy specifies when tissue-based and plasma-based testing may be considered medically necessary for targeted therapy selection.
Action Required
Before February 1, 2026: Billing and prior authorization teams must review current biomarker testing protocols for NSCLC patients. Ensure documentation includes specific gene variants, FDA-approved therapy indications, and justification for liquid biopsy when tissue is not feasible. Update pre-authorization processes to align with new coverage criteria for tissue vs. plasma testing.