Medicare AdvantageCoverageMedium impact
Genetic Testing Services
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Pulmonology, Pathology·Physician / Facility
Effective date
Nov 1, 2021
We identified it
Jun 19, 2026
Summary
Effective November 1, 2021, genetic testing CPT code 81538 is now covered for Medicare Advantage plans when billed with specific lung and pleural cancer diagnosis codes. Commercial plans continue to exclude this service as not medically necessary.
Action Required
Billing team must update system to allow CPT 81538 for genetic testing services only for Medicare Advantage plans when paired with diagnosis codes C33, C34-C34.92, C38.4, or C45.0. Ensure commercial plans continue to deny this service. Update encounter forms and billing edits accordingly.