BCBS M – Blue Cross highlights medical, benefit policy changes

Gene expression assay testing in tumor tissue for treatment guidance for breast cancer patients

81518, 81519, 81520, 81521, 81522, 81523

Experimental
81599,** 84999,** S3854,*** 0045U, 0153U

The safety and effectiveness of reverse-transcriptase polymerase chain reaction, or RT-PCR assays (i.e., Oncotype DX®, EndoPredict®, Breast Cancer Index®, MammaPrint® and Prosigna®) for determining whether to undergo adjuvant chemotherapy may be considered established. They are useful diagnostic tests for predicting the likelihood of early cancer recurrence (0 to 5 years) in individuals who meet the inclusionary guidelines.

Source: https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2023/dec/Record_01223i.html