Molecular Pathology Laboratory Network

Tennessee BCBS Medical Policy Manual

Effective 11/12/11 BCBS of Tennessee considers EGFR mutation analysis medically appropriate with  ALL of the following criteria:

1. Non-small cell lung cancer not associated with squamous cell type
2. Testing is used to predict treatment response to tyrosine kinase inhibitors (erlotinib, gefitinib)
3. Analysis of Exon 19 small deletions or Exon 21 point mutation (L858R)

Analysis for mutations including other mutations within exons 18-24, or other applications related to NSCL, is considered investigational.

North Carolina BCBC Medical Policy Manual

Effective 8/2011 BCBS of North Carolina may consider EGFR mutation analysis medically necessary when:

1. Analysis of Exon 19 small deletions or Exon 21 point mutation (L858R)
2. Testing is used to predict treatment response to erlotinib in NSCLC

Analysis of Exon 19 deletiona and Exon 21 (L858R) is considered investigational for patients with advanced squamous type NSCLC. Analysis for  other mutations within exons 18-24, or other applications related to NSCLC, is considered investigational.

 BCBS Resouces March 2011: Epidermal Growth Factor Receptor Mutations and Tyrosine Kinase Inhibitor Therapy in Advanced Non-Small-Cell Lung Cancer