Acute Hepatitis Panel
Effective May 1, 2026, for CPT code 80074, the covered diagnosis list will be updated to include additional covered diagnosis codes for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease
Effective May 1, 2026, for CPT codes 83700, 83701 and 83704, the covered diagnosis list will be updated to include additional covered diagnosis codes for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Carcinoembryonic Antigen (CEA) Testing
Effective May 1, 2026, for CPT code 82378, the covered diagnosis list will be updated to include additional covered diagnosis codes for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Serum Tumor Markers for Breast and Gastrointestinal Malignancies
Effective May 1, 2026, for CPT code 86300, the covered diagnosis list will be updated to include additional covered diagnosis codes for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
Effective May 1, 2026, CPT code 0591U will be added to this policy and will change from prior authorization to not covered for Medicare Advantage plans and not medically necessary for commercial products. For additional details related to this policy, please click here.
CA 125
Effective May 1, 2026, the following additional ICD-10 Diagnosis Codes C53.1, C53.8, C53.9, Z84.A, Z85.4A, Z91.B will be added to this medical policy as medically necessary for CPT 86304. CPT 86304 will continue to be medically necessary for Medicare Advantage plans and commercial products when submitted with covered diagnosis codes included in this policy. For additional details related to this policy, please click here.
Adjunctive Techniques for Screening, Surveillance, and Risk Classification of Barrett Esophagus and Esophageal Dysplasia
Effective May 1, 2026, CPT 0398U (Esopredict) will be added to this medical policy where it will be not covered for Medicare Advantage plans and not medically necessary for commercial products. Additionally, effective May 1, 2026, the BarreGEN test (CPT 81479) will be removed from this policy as the test has been discontinued. No other changes were made to this policy. For additional details related to this policy, please click here.
Implantation of Anterior Segment Intraocular Nonbiodegradable Drug-Eluting System
Effective April 1, 2026, this policy will be changed to state the service is covered for Medicare Advantage plans and commercial products.
For additional details related to this policy, please click here.
Focal Treatments for Prostate Cancer
For CPT 0601T, a correction was made and 0601T will not be added to this policy, effective March 1, 2026. CPT 0601T will stay in the New Technology and Miscellaneous Services Policy.
Behavioral Health Outpatient Professional Services
Effective May 1, 2026, psychological and neuro-psychological testing will be limited to the following specialties: Psychologists and pediatric neurodevelopmental specialists. The services provided by the following specialty has also been revised: Licensed Chemical Dependency Professionals (LCDP). For additional details related to this policy, please click here.
Psychological and Neuropsychological Testing
Effective May 1, 2026, psychological and neuro-psychological testing will be limited to the following specialties: Psychologists and pediatric neurodevelopmental specialists. For additional details related to this policy, please click here.
Prior Authorization of Drugs
Effective May 1, 2026, the Prior Authorization of Drugs Medical Policy will have the Pharmacy Vendor contact information updated in this medical policy. Changes include Pharmacy Vendor’s contact phone number, contact fax, website and revised information about submitting Prior Authorization requests. This applies to both Medicare Advantage Plans and Commercial Products. For additional details related to this policy, please click here.