CommercialCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Oncology, Pulmonology·Medical Policy
Effective date
Mar 1, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated coverage criteria for genetic testing in non-small cell lung cancer, adding restricted coverage for FoundationOne CDx (0037U) and establishing specific criteria for liquid biopsy tests. They also established a new policy of non-coverage for TOMAC therapy for restless legs syndrome.
Action Required
Before March 1, 2026: Billing team must update prior authorization requirements for liquid biopsy genetic tests (codes 0037U, 0239U, 0242U, 0388U) to verify all three criteria are met: insufficient tumor tissue available, no prior NGS testing performed, and test used for ASCO-recognized actionable mutations. Stop billing TOMAC procedures for restless legs syndrome as they will be denied. Update billing system edits and provider documentation templates.