MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Oncology, Psychiatry, Internal Medicine +6 more·Medicaid
Effective date
Apr 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has updated their pharmacogenomics testing policy, defining specific coverage for DPYD and NUDT15/TPMT genetic tests while explicitly excluding numerous other pharmacogenomic tests. Only tests for guiding fluoropyrimidine and thiopurine medication dosing or managing severe toxicity from these medications will be covered.
Action Required
By April 1, 2025: Update billing system to flag only CPT codes 81232, 81306, and 84433 as covered for Humana Medicaid SC members when used for guiding fluoropyrimidine or thiopurine medication therapy or managing severe toxicity. Block or flag all other pharmacogenomic test codes listed in the coverage limitations as non-covered. Train billing staff on the specific coverage criteria requiring medication therapy indication.