CommercialAdministrativeMedium impact
Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer
Blue Cross Blue Shield of Rhode Island·RI · Oncology, OB-GYN·Physician / Facility
Effective date
Apr 1, 2022
We identified it
Jun 19, 2026
Summary
BCBS RI has moved Oncotype DX Breast medical necessity review criteria from their online authorization tool to a formal medical policy, effective April 1, 2022. Providers must now refer to the draft medical policy for coding and coverage details instead of using the previous authorization tool.
Action Required
Immediately: Billing team must stop using the online authorization tool for Oncotype DX Breast genetic testing. Review the draft medical policy referenced in the update for current coding and medical necessity criteria. Update billing workflows to reference the new medical policy instead of the authorization tool for all BCBS RI commercial products.