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Genetic Testing for Diagnosis of Inherited Conditions - Medicare Advantage (Revised)

Humana·Genetics, Neurology, Cardiology +4 more·Medicare Advantage
Effective date
Mar 2, 2026
We identified it
Jun 24, 2026
Days to comply

Summary

Humana Medicare Advantage updated their genetic testing policy for inherited conditions, providing new coverage criteria and limitations. The policy consolidates coverage rules for various genetic tests including multigene panels, whole genome/exome sequencing, and short tandem repeat analysis.

Action Required

Action needed
Before March 2, 2026: Review updated Humana Medicare Advantage genetic testing coverage criteria for inherited conditions. Update billing processes to align with new coverage determinations and ensure compliance with analytical validity, clinical validity, and clinical utility standards for molecular diagnostic tests. Verify coverage requirements against applicable MAC LCDs for your jurisdiction.

Affected Billing Codes

81265
81266
81267
81268