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Regence BlueShieldAll Plans · Coverage · Coding · Genetics, OncologyMedium impact

Evaluating the Utility of Genetic Panels

Effective date
Oct 1, 2026
Identified
Jul 7, 2026

Summary

Genetic panel tests are considered investigational when there is not enough research to show that a gene or gene variant in the panel can be used to manage treatment decisions and improve net health outcomes. When that evidence is missing, the entire panel is considered investigational, with or without optional add-on genes, and the criteria list specific named panel tests under this rule. Contracts exclude investigational services from coverage.

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What to do

Action · 4 steps
01Already effective October 1, 2026: Submit the following for review: the name of the genetic test or panel, the performing laboratory, the exact genes or variants being tested, the relevant billing codes, a brief description of how the results will guide clinical decisions that would not otherwise be made without the test, and medical records if available (history and physical exam, conventional testing and outcomes, and conservative treatment provided).
02Clinical documentation is required to support the criteria.
03Patients should receive pre- and post-test genetic counseling from a qualified professional when testing is performed to diagnose or predict susceptibility for inherited diseases.
04Providers may bill members for services considered investigational and are encouraged to inform members before rendering them that the members are likely to be financially responsible for the cost.

Codes mentioned

81479

Original notice

Evaluating the Utility of Genetic Panels
beonbrand.getbynder.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Regence BlueShield policiesGeneticsOncologyCode 81479

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