CommercialPrior AuthHigh impact
Genetic Testing Update
Blue Cross Blue Shield of Nebraska·NE · Oncology, Genetics, Gastroenterology +1 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska is updating genetic testing policies effective January 1, 2026, requiring preauthorization for specific oncology-related genetic tests including CDH1, BAP1, hereditary polyposis panels, and hereditary breast/ovarian cancer panels. The policy establishes detailed medical necessity criteria for each test type and expands coverage for molecular profiling via circulating tumor DNA.
Action Required
By January 1, 2026: Billing team must update prior authorization requirements for all genetic testing related to hereditary cancer, polyposis, and molecular profiling. Update billing system to flag these services for preauth verification. Train staff on new medical necessity criteria for CDH1, BAP1, hereditary polyposis panels, and BRCA testing. Claims without proper preauthorization will be denied.