Medicare AdvantageCoverageMedium impact
Pharmacogenomics Testing - Medicare Advantage (Revised)
Humana·Pharmacy, Genetics, Internal Medicine +4 more·Pharmacy
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated its pharmacogenomics testing policy, establishing coverage criteria for genetic testing that determines medication effectiveness and safety. The policy provides specific coverage for CYP27A1 testing for cerebrotendinous xanthomatosis diagnosis when clinical manifestations are present.
Action Required
Before December 1, 2025: Billing team must review pharmacogenomics test ordering to ensure tests meet CMS LCD/LCA requirements and are in the DEX Diagnostics Exchange Registry. Providers must document clinical manifestations (chronic diarrhea, bilateral cataracts, tendon xanthomas, neurologic dysfunction) for CYP27A1 testing orders. Update prior authorization workflows to verify test medical necessity criteria are met before ordering.