CommercialAdministrativeMedium impact
06.02.10r, Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (Independence Administrators)
Independence Blue Cross·Gastroenterology, Oncology, Pathology +3 more·Medical Policy
Effective date
Sep 16, 2026
We identified it
Jun 19, 2026
Summary
This is a reissue with no substantive policy changes to Independence Administrators' genetic testing coverage for FAP and Lynch syndrome. The only modification is updated disclaimer language clarifying that this policy applies only to members whose groups have NOT enrolled in the UM vendor program; groups enrolled in the vendor program should refer to the eviCore Lab Management Program instead. Billing teams must verify member enrollment status before authorizing or billing for genetic testing.
Action Required
By September 16, 2026: Billing team must update member verification protocols to confirm whether a member's group is enrolled in Independence Administrators' UM vendor program BEFORE processing genetic testing claims (CPT 81201, 81202, 81203, 81301, G0452, S0265). If the group is enrolled in the vendor program, redirect claims and prior authorization requests to the eviCore Lab Management Program policy instead of this policy. Update internal billing system notes or lookup tools to reflect the new applicability criteria. Failure to verify enrollment status may result in claim denials or incorrect policy application.