CommercialCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Oncology, OB-GYN, Pathology·Medical Policy
Effective date
Mar 1, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross has expanded coverage criteria for genetic and biomarker testing in ovarian cancer, adding restricted coverage for multiple new tests including NTRK gene fusion analysis, tumor mutational burden, RET gene fusion, FOLR1 protein expression, BRAF V600E testing, and liquid ctDNA testing to determine candidacy for targeted therapies.
Action Required
Before March 1, 2026: Billing team must update system to recognize restricted coverage for the newly added genetic testing codes for ovarian cancer patients. Ensure proper documentation of Primary Coverage Criteria is met before billing, including verification of recurrent/persistent ovarian cancer diagnosis, candidacy for specific targeted therapies, and for liquid biopsy testing (0239U), confirm insufficient tissue availability or unsafe biopsy conditions. Update encounter forms to remind providers of new coverage criteria.