Medical Policy Update For April 21, 2022

April 21, 2022

Reimbursement Policy	Revision
Microsatellite Instability and Tumor Mutational Burden Testing AHS-M2178 (PDF)	New policy developed. BCBSNC will provide coverage for 1) tumor mutational (TMB) testing (Note 1) for solid tumors (Note 3) done on tissue or liquid biopsy (Note 2) is considered medically necessary for individuals being considered for Pembrolizumab (Keytruda) therapy and 2) microsatellite instability (MSI) testing (Note 3) by tissue or liquid biopsy (Note 2) for all solid tumors is considered medically necessary for individuals being considered for Pembrolizumab (Keytruda).

Reimbursement Policy

Revision

Microsatellite Instability and Tumor Mutational Burden Testing AHS-M2178 (PDF)

New policy developed. BCBSNC will provide coverage for 1) tumor mutational (TMB) testing (Note 1) for solid tumors (Note 3) done on tissue or liquid biopsy (Note 2) is considered medically necessary for individuals being considered for Pembrolizumab (Keytruda) therapy and 2) microsatellite instability (MSI) testing (Note 3) by tissue or liquid biopsy (Note 2) for all solid tumors is considered medically necessary for individuals being considered for Pembrolizumab (Keytruda).

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