MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - FLORIDA (Revised)
Humana·FL · Oncology, Psychiatry, Family Medicine +3 more·Medicaid
Effective date
Apr 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Florida Medicaid has updated their pharmacogenomics testing policy, now covering only DPYD genotype testing (81232) and NUDT15/TPMT genotype testing (81306, 84433) for specific medication guidance indications. All other pharmacogenomics tests including comprehensive panels, behavioral health tests, and oncology-related tests are non-covered.
Action Required
Before April 1, 2025: Billing team must update prior authorization requirements for Florida Medicaid pharmacogenomics testing. Only approve CPT 81232 (DPYD), 81306 (NUDT15), and 84433 (TPMT) for medication dosing guidance or severe toxicity indications. All other pharmacogenomics codes including comprehensive panels and behavioral health tests must be denied as non-covered. Update billing system denial reasons and provider notification protocols.