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Gene Expression Profiling for Noncancer Indications - Medicare Advantage (Revised)
Effective date
Nov 3, 2025
Identified
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their policy for gene expression profiling tests used for non-cancer conditions, establishing specific coverage criteria and referencing multiple Medicare Administrative Contractor Local Coverage Determinations. This policy specifically covers tests like the Envisia Genomic Classifier for idiopathic pulmonary fibrosis diagnosis.
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What to do
Action · 3 steps
01Before November 3, 2025: Billing team must review coverage criteria for gene expression profiling tests for non-cancer indications (especially CPT 81554 - Envisia Genomic Classifier).
02Verify that documentation includes: patient is within appropriate population for testing, test results will directly impact treatment/management, and physician ordering test is treating the beneficiary.
03Update prior authorization workflows to reference applicable MAC LCD requirements based on practice location.
Codes mentioned
81554
Original notice
Gene Expression Profiling for Noncancer Indications - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Molecular Biomarker Testing for Noncancer Indications - MEDICAID - KENTUCKY (Revised)HighEffective Sep 23, 2026 · MedicaidGene Expression Profiling for Noncancer Indications - Medicare Advantage (Revised)MediumEffective Aug 3, 2026 · Medicare AdvantageGene Expression Profiling for Cancer Indications - Medicare Advantage (Revised)MediumEffective May 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list