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, Pathology·Physician / Facility
Effective date
Nov 1, 2021
We identified it
Jun 19, 2026
Summary
Effective November 1, 2021, prior authorization criteria for four breast cancer genetic expression assays (Breast Cancer Index, Prosigna, MammaPrint, and EndoPredict) moved from the online authorization tool to a new medical policy for commercial products. Billing teams must now refer to the draft medical policy for coding and coverage details instead of using the previous online authorization system.
Action Required
Immediately: Billing team must stop using the online authorization tool for Breast Cancer Index, Prosigna, MammaPrint, and EndoPredict tests for commercial patients. Access and review the draft medical policy at the provided URL for current coding requirements and coverage criteria. Update billing workflows to reference the new medical policy instead of the online authorization tool for these four genetic expression assays.