MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - KENTUCKY (New)
Humana·KY · Oncology, Psychiatry, Pharmacy +2 more·Medicaid
Effective date
Nov 12, 2025
We identified it
Jun 24, 2026
Summary
Humana Kentucky Medicaid has established a new pharmacogenomics testing policy effective November 12, 2025. The policy covers only DPYD genotype testing (81232) and NUDT15/TPMT genotype testing (81306, 84433) for specific medication dosing guidance, while explicitly excluding coverage for all other pharmacogenomic tests including comprehensive panels and behavioral health genetic testing.
Action Required
Before November 12, 2025: Billing team must update Kentucky Medicaid claims processing to only bill DPYD genotype testing (81232) and NUDT15/TPMT genotype testing (81306, 84433) when performed prior to fluoropyrimidine or thiopurine therapy initiation or for severe toxicity reactions. Stop billing all other pharmacogenomic tests for Kentucky Medicaid members as they are explicitly non-covered. Update denial management protocols for the 20+ excluded test codes.