All PlansCoverageMedium impact
06.02.43b, Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)
Independence Blue Cross·OB-GYN, Oncology, General Surgery·Pharmacy
Effective date
Sep 3, 2025
We identified it
Jun 19, 2026
Summary
Policy 06.02.43b addresses coverage for proteomic (protein)-based testing using OVA1® and ROMA™ for evaluating ovarian/adnexal masses. This is a reissued policy effective 09/03/2025. The billing team must review the specific coverage criteria, prior authorization requirements, and billing code requirements outlined in the full policy text to ensure compliant claims submission for these specialized diagnostic tests.
Action Required
By 09/03/2025: Billing team must access the full policy text at the provided URL to identify specific CPT/HCPCS codes for OVA1® and ROMA™ testing, determine prior authorization requirements, and establish workflow rules in billing software. Update provider education materials and encounter forms to ensure OVA1® and ROMA™ test orders include required documentation for medical necessity. Verify coverage criteria (patient population, clinical indications) and implement denial prevention measures. Contact payer if specific billing codes are not clearly stated in the policy excerpt provided.