Medicare AdvantagePrior AuthMedium impact
Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management
Blue Cross Blue Shield of Rhode Island·RI · Urology, Oncology·Physician / Facility
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
Effective October 1, 2019, the Prolaris™ assay (CPT 81541) will no longer require prior authorization for BlueCHiP for Medicare as it becomes a non-covered service. The OncotypeDX AR-V7 Nuclear Detect assay (CPT 81479) will now require prior authorization for BlueCHiP for Medicare and remains not medically necessary for commercial products.
Action Required
By October 1, 2019: Billing team must update system to remove prior authorization requirements for CPT 81541 for BlueCHiP Medicare (service now non-covered - claims will be denied). Add prior authorization requirement for CPT 81479 through online authorization tool for BlueCHiP Medicare only. Update encounter forms to reflect these changes for prostate cancer genetic testing orders.