MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - MICHIGAN (New)
Humana·MI · Genetics, Internal Medicine, Family Medicine +3 more·Medicaid
We identified it
Jul 17, 2026
Summary
Michigan Medicaid has issued a new policy establishing coverage for pharmacogenomics testing, which is laboratory testing used to determine how a patient's genetic factors affect medication safety, effectiveness, and treatment response. The billing team must identify the applicable CPT/HCPCS codes for pharmacogenomics testing and implement billing procedures specific to Michigan Medicaid to avoid claim denials.
Action Required
Immediately: Billing team must obtain the complete Michigan Medicaid pharmacogenomics testing policy from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a57fc6d) to identify specific CPT/HCPCS codes, coverage criteria, and prior authorization requirements. Update billing software to recognize pharmacogenomics testing claims for Michigan Medicaid members. Coordinate with providers to ensure proper documentation of medical necessity. Establish internal procedures to verify coverage eligibility before billing. Monitor for policy updates from Humana regarding effective dates and specific code mappings, as this summary-only version lacks critical billing details needed for claim submission.