All PlansCoverageMedium impact
Circulating Tumor DNA (Liquid Biopsy)
BCBS Tennessee·Oncology, Hematology·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
New medical policy establishes coverage criteria for circulating tumor DNA (liquid biopsy) testing. FDA-approved companion diagnostic assays like FoundationOne Liquid CDx and Guardant360 CDx are considered medically necessary for advanced/metastatic solid tumors when specific criteria are met, while Signatera testing remains investigational.
Action Required
Before July 31, 2026: Billing team must establish pre-authorization processes for circulating tumor DNA (liquid biopsy) testing. Verify all four medical appropriateness criteria are met before submitting claims: 1) Advanced/metastatic solid tumor diagnosis, 2) FDA-approved companion diagnostic being used, 3) FDA label requires companion diagnostic testing, 4) No previous somatic tumor testing performed. Do not bill for Signatera testing as it will be denied as investigational.