MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - INDIANA (Revised)
Humana·IN · Pharmacy, Internal Medicine, Family Medicine +4 more·Medicaid
We identified it
Jul 17, 2026
Summary
Indiana Medicaid has issued a revised policy on pharmacogenomics testing, defining it as laboratory testing to determine how genetic factors affect medication safety, effectiveness, and individual response. This is a definitional/informational policy update from Humana that clarifies coverage parameters for genetic testing related to medication optimization.
Action Required
Immediately: Billing team must review current pharmacogenomics testing claims submitted to Indiana Medicaid to ensure alignment with this revised policy definition. Verify that all pharmacogenomics tests are being billed with appropriate laboratory codes (typically CPT 81355, 81356, 81357, or similar genetic testing codes depending on the specific test panel). Contact Humana Indiana Medicaid for clarification on: (1) specific CPT codes covered under this policy, (2) prior authorization requirements, (3) medical necessity documentation standards, and (4) effective date of this revision. Update internal coding guidelines and provider communication materials once specific billing codes and requirements are confirmed. Do not delay claims pending clarification, but flag for review to ensure compliance with the updated policy parameters.