Medicare AdvantageCoverageMedium impact
Revised medical criteria for Decipher test
Blue Cross Blue Shield of Rhode Island·RI · Urology, Oncology·Physician / Facility
Effective date
Sep 1, 2021
We identified it
Jun 19, 2026
Summary
Effective September 1, 2021, Medicare Advantage Plans revised medical criteria for the Decipher gene expression profiling test used in prostate cancer management, based on CMS local coverage determination guidance. The test remains not medically necessary for commercial insurance products.
Action Required
Review updated medical policy for Decipher test coverage criteria by clicking the provided link. Billing team should verify Medicare Advantage coverage requirements before submitting claims for Decipher testing and ensure commercial plans continue to deny coverage as not medically necessary.