Effective Jan. 1, 2021, BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan will implement a new medical policy addressing better ways of detecting minimal residual disease. The policy, CAM 251 – Minimal Residual Disease, will be added to the Medical Policies page, which can be accessed through www.SouthCarolinaBlues.com and www.BlueChoiceSC.com.
Minimal Residual Disease, also known as measurable residual disease (MRD), is a term used by physicians when treating patients that have blood cancers. It refers to the subclinical levels of residual diseases, such as acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) and multiple myeloma (MM), where cancer cells remain after treatment that cannot be detected by the same scans or tests use prior to treatment.
MRD is a postdiagnosis, prognostic indicator that can be used for risk stratification and to guide therapeutic options when used alongside other clinical and molecular data. Many different techniques have been developed to detect residual disease; however, PCR-based techniques, multicolor flow cytometry and deep sequencing-based MRD generally provide better sensitivity, specificity, reproducibility and applicability than other techniques, such as fluorescence in situ hybridization (FISH), Southern blotting or cell culture.
A portion of the policy reads:
1. Minimal residual disease (MRD) testing by multiparameter flow cytometry and next-generation sequencing is considered MEDICALLY NECESSARY for individuals with multiple myeloma, including:
- During follow-up or surveillance after response to primary therapy
- After each treatment state (i.e., after induction, high-dose therapy/autologous stem-cell transplantation, consolidation and maintenance)
2. MRD testing by multiparameter flow cytometry (standardized ERIC method to at least a sensitivity of 10-4) and next-generation sequencing is considered MEDICALLY NECESSARY for individuals with chronic lymphocytic leukemia or small lymphocytic lymphoma, including:
- After the end of the treatment
- For consideration of therapy with lenalidomide for high-risk patients after first-line therapy
For complete information on CAM 251, visit our Medical Policies page. You may contact Provider Education at Provider.Education@bcbssc.com with any questions that you have on this bulletin.