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Pharmacogenetic Testing for Pain Management
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Genetic testing for pain management is considered investigational for all indications under this policy. Genetic testing for acute pain management to assess the risk of developing opioid use disorder is also considered investigational for all indications, including the AvertD test that detects single nucleotide polymorphisms involved in the brain reward pathway. Investigative services are defined as not yet recognized as a generally accepted standard of good medical practice for the condition being treated, and are therefore not considered medically necessary.
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What to do
Action · 5 steps
01REQUIREMENTS: Billing team: Stop billing the pharmacogenetic and genetic testing codes listed in this policy as medically necessary for pain management, because genetic testing for pain management is considered investigational for all indications.
02Billing team: Stop billing genetic testing for acute pain management to assess the risk of developing opioid use disorder as medically necessary, because that testing is considered investigational for all indications.
03Billing team: For testing limited to cytochrome P450 genotyping, check the Cytochrome P450 Genotype-Guided Treatment Strategy medical policy, because this policy does not address that testing.
04Providers and front desk staff: Tell them that genetic testing for pain management is investigational under this policy.
05BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary.
Codes mentioned
81225812268122781230812318129181401
Original notice
Pharmacogenetic Testing for Pain Management
bcbsms.com · Always check the source before changing claims.
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