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Evaluation of Cerebrospinal Fluid, Urine, and Plasma Tests for Alzheimer Disease
BCBS Arizona·AZ · Neurology, Geriatrics, Internal Medicine·Medical Policy
Effective date
Jul 29, 2026
We identified it
Aug 14, 2026
Summary
This new policy establishes coverage criteria for cerebrospinal fluid, urine, and plasma biomarker tests for Alzheimer disease diagnosis and amyloid pathology confirmation. The policy recognizes FDA-authorized amyloid CSF ratio tests and plasma p-tau217/β-Amyloid 1-42 ratio tests as clinically equivalent to amyloid PET scans for identifying candidates for anti-amyloid therapy (lecanemab and donanemab).
Action Required
By July 29, 2026: Billing team must update clinical policy references in billing system, prior authorization workflows, and claim adjudication rules to recognize coverage for amyloid CSF ratio tests and plasma p-tau217/β-Amyloid 1-42 ratio tests when used to confirm amyloid pathology prior to anti-amyloid therapy. Coordinate with providers and neurology departments to ensure they understand these tests are now recognized as equivalent to amyloid PET for therapy eligibility determination. Update prior authorization templates to accept CSF biomarker testing (t-tau/Aβ1-42 ratios) and plasma biomarker testing (p-tau217/β-Amyloid 1-42 ratios) as acceptable confirmatory tests per FDA guidance. Train billing and clinical staff on documentation requirements linking biomarker results to amyloid-targeted therapy initiation or discontinuation decisions. Monitor claims for these test types to ensure appropriate processing and reimbursement.