Biomarkers for Oncology
JH · Effective Oct 1, 2015
27 active Medicare policies list 81538, and 6 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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JH · Effective Oct 1, 2015
JL · Effective Oct 1, 2015
JH · Effective Oct 1, 2015
JL · Effective Oct 1, 2015
J9 · Effective Jul 17, 2023
JH · Effective Jul 17, 2023
JL · Effective Jul 17, 2023
J15 · Effective Oct 1, 2015
JE · Effective Oct 1, 2015
JF · Effective Oct 1, 2015
6 policies from 6 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 81538 |
|---|---|---|
| Tumor Markers | Mar 5, 2024 | Covered |
| Policy | Effective | Status of 81538 |
|---|---|---|
| Concert Genetic Testing Oncology: Algorithmic Assays | Not recorded | Referenced |
| Policy | Effective | Status of 81538 |
|---|---|---|
| Selected Protein Biomarker Algorithmic Assays | Oct 1, 2026 | Not covered |
JJ · Effective Oct 1, 2015
JM · Effective Oct 1, 2015
J5 · Effective Feb 16, 2017
J8 · Effective Feb 16, 2017
J9 · Effective Oct 1, 2015
J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
JL · Effective Apr 24, 2025
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
J5 · Effective Jul 1, 2026
JL · Effective Jul 1, 2026
J9 · Effective Jul 1, 2026
J6 · Effective Jul 15, 2026
| Policy | Effective | Status of 81538 |
|---|---|---|
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 81538 |
|---|---|---|
| Multianalyte Assays with Algorithmic Analyses for Cancer Indications | May 1, 2026 | Covered |
| Policy | Effective | Status of 81538 |
|---|---|---|
| Analysis of Proteomic and Metabolomic Patterns for Cancer Detection, Risk, Prognosis, or Treatment Selection | Mar 1, 2026 | Covered |