MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - VIRGINIA (Revised)
Humana·VA · Psychiatry, Oncology, Genetics +2 more·Medicaid
Effective date
Apr 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Virginia Medicaid updated their pharmacogenomics testing policy, covering only DPYD, NUDT15, and TPMT genetic tests for specific medication dosing guidance, while excluding all other pharmacogenomic tests including behavioral health panels and comprehensive testing. Most pharmacogenomic tests will not be covered due to insufficient evidence.
Action Required
Before April 1, 2025: Billing team must update system to only bill CPT 81232 (DPYD), 81306 (NUDT15), and 84433 (TPMT) for Virginia Medicaid pharmacogenomic testing when performed prior to medication therapy or for severe toxicity. Remove all other pharmacogenomic test codes from Virginia Medicaid billing options including behavioral health panels (0345U, 0423U, 0437U) and comprehensive tests (0438U, 0349U). Claims for excluded tests will be denied.