CommercialCoverageMedium impact
Circulating Tumor DNA for Management of Cancer (Liquid Biopsy) 2.02.56
Excellus BlueCross BlueShield·Oncology, Hematology, Pathology·Lab Tests (pathology)
Effective date
Feb 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new coverage criteria for circulating tumor DNA (liquid biopsy) testing, specifying when these tests are medically appropriate for various cancer types including colorectal, lung, melanoma, pancreatic, ovarian, prostate, and breast cancers. The policy requires FDA approval for the specific tumor type and limits coverage to specific targeted gene mutations, while deeming comprehensive genomic profiling investigational.
Action Required
Before February 19, 2026: Billing team must update prior authorization processes to verify liquid biopsy tests meet specific criteria including FDA approval for tumor type and targeted gene mutation requirements. Providers must ensure documentation includes specific cancer type and targeted genes being tested. Claims for comprehensive genomic profiling (FoundationOne Liquid CDx, Guardant 360) will be denied as investigational.