Medicare AdvantageCoverageMedium impact
Gene Expression Profiling for Noncancer Indications - Medicare Advantage (Revised)
Humana·Pulmonology, Pathology, Genetics·Medicare Advantage
Effective date
Nov 3, 2025
We identified it
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.
Action Required
Before November 3, 2025: Billing team must review coverage criteria for gene expression profiling tests for non-cancer indications (especially CPT 81554 - Envisia Genomic Classifier). Verify 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. Update prior authorization workflows to reference applicable MAC LCD requirements based on practice location.