Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies

Updated Description Section:

▪ Replaced previous policy statement “The use of comprehensive genomic profiling for selecting targeted cancer treatment is considered experimental / investigational” with the current policy statement.

A. The use of comprehensive genomic profiling for selecting targeted cancer treatment is considered medically necessary when all the following criteria are met:

1. The individual has not previously had comprehensive genomic profiling panel testing performed on the tumor; AND

2. The individual has been diagnosed with recurrent, relapsed, refractory, metastatic, or advanced stages III or IV cancer; AND

3. The individual has one of the following cancer types: a. Breast Cancer, OR b. Colorectal Cancer, OR c. Melanoma, OR d. Non-small cell lung cancer, OR e. Ovarian Cancer, OR f. Pancreatic Cancer, OR g. Prostate Cancer, AND

4. The individual has decided to seek further treatment (e.g. therapeutic chemotherapy); AND

5. The comprehensive genomic profiling panel has received FDA approval or Clinical Laboratory Improvement Amendments (CLIA) validation as a companion in vitro diagnostic

B. The use of comprehensive genomic profiling panels is considered experimental / investigational when the above criteria has not been met.

Updated Policy Guideline Section

 ▪ Removed Policy Guidelines Update Rationale Section Updated Coding Section

▪ Changed ICD-10 DIAGNOSES section from “Experimental / Investigational for all diagnoses related to this medical policy” to “An appropriate ICD-10 diagnosis code should be used when reporting comprehensive genomic profiling for selecting targeted cancer therapies.”

▪ Added: 0288U, 0329U, and 0334U(effective 10-01-2022); 81449, 81451, and 81456 (effective 01-01-2023)

▪ Updated nomenclature for 0016M, 81445, 81450, 81455

▪ Deleted: 0013U, 0014U, 0056U (effective 9/30/2022)

Source: https://www.bcbsks.com/medical-policies/comprehensive-genomic-profiling-selecting-targeted-cancer-therapies