All PlansCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Pulmonology, Internal Medicine·Medical Policy
Effective date
Sep 1, 2026
We identified it
Jun 30, 2026
Summary
Two molecular testing procedures for pulmonary nodule evaluation are being removed from coverage effective September 1, 2026: Percepta Genomic Sequencing Classifier (gene expression profiling on bronchial brushings) and REVEAL Lung Nodule Characterization (plasma-based proteomic screening including Nodify XL2 and Nodify CDT). Both tests no longer meet coverage criteria due to insufficient scientific evidence of effectiveness in improving health outcomes, and one product is no longer marketed.
Action Required
By August 31, 2026: Billing team must update billing software to deny claims for Percepta Genomic Sequencing Classifier and REVEAL Lung Nodule Characterization (including Nodify XL2, Nodify CDT, and MagArray). Update prior authorization system to automatically deny requests for these tests under this policy. Notify pulmonology providers and respiratory specialists of the coverage removal and document the policy change in the system. Implement denial messaging that references policy 2017019 effective 9/1/2026. Any claims submitted after this date for these tests will be denied as non-covered services. Review any pending claims for these tests and contact patients/providers before the effective date for appeals or alternative testing options.