All PlansCoverageHigh impact
Evaluating the Utility of Genetic Panels
Regence BlueShield·Genetics, Oncology, Neurology +6 more·Coding
Effective date
Jul 1, 2026
We identified it
Jul 7, 2026
Summary
This new policy (effective July 1, 2026) establishes coverage criteria for genetic panel tests, designating panels without demonstrated clinical utility for their genes as investigational. The policy provides a comprehensive list of genetic panels across multiple laboratories and conditions that require clinical documentation to support medical necessity. Billing teams must verify that genetic panel tests ordered have documented clinical utility before submitting claims, as investigational panels will be denied.
Action Required
By June 15, 2026: Billing team must review the comprehensive genetic panel list in policy GT64 and cross-reference all incoming genetic panel orders against the policy. For panels listed without a Policy Cross-Reference (indicating investigational status), require providers to submit clinical documentation demonstrating medical necessity BEFORE processing claims. Implement a billing system flag or checklist to identify genetic panel CPT codes (including 81415-81416, 81430-81431, and similar genetic sequencing codes) and route them for pre-billing review. Update encounter forms and laboratory requisition templates to require providers to justify clinical utility for any genetic panel ordered. Communicate to all ordering providers that claims for genetic panels without documented clinical utility will be denied. For panels WITH Policy Cross-References (e.g., GT02, GT06, GT10, GT53, GT59, GT81, GT82), apply the criteria from the referenced policies. Establish a process to monitor denials and track which panels are most frequently questioned so providers can be educated.