Blue Cross and Blue Shield of MinnesotaAll Plans · Coverage · Medical Policy · Dermatology, Gastroenterology, Infectious Disease +15 moreMedium impact
Upcoming Policies effective December 1, 2026
Effective date
Dec 1, 2026
Identified
Oct 15, 2026
Summary
The policies listed under Policies Developed take effect December 1, 2026, and the notification was posted October 14, 2026. They set coverage criteria for tests in infectious disease, gastroenterology, oncology, reproductive, cardiovascular, dermatology, endocrinology, hematology, immunology and rheumatology, neurology, ophthalmology and musculoskeletal areas, and most tests are medically necessary only when the listed criteria are met and are investigational for all other indications. Multi-cancer early detection screening tests and cancer exome and genome sequencing are considered investigational for all indications.
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01Before December 1, 2026: Billing team, bill each test only when the member meets the criteria the policy lists for that test.
02Examples from the policy: culture-independent molecular tests (NAAT/PCR) for onychomycosis are medically necessary when conventional diagnostic techniques were inconclusive and results would influence clinical management; syndromic gastrointestinal pathogen panels with 11 or fewer targets are medically necessary once per incident of diarrheal disease, or no more than once per 14-day period; and HPV genotyping of high risk types is medically necessary once every 5 years for individuals between the ages of 30 and 65 years in the absence of increased risk factors for cervical cancer.
03Fragile X (81243) and spinal muscular atrophy (SMA) (81329) carrier screening may be billed along with 81443 if performed separately from the remainder of the panel per CPT Code Book Guidelines, and if 81243 is billed along with 81443, the member should still meet the specific Fragile X syndrome criteria.
04Tests listed as investigational for all indications, such as multi-cancer early detection screening tests, are investigational under this policy.
Codes mentioned
812438132981443
Original notice
Upcoming Policies effective December 1, 2026
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