MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Genetics, Pharmacy·Medicaid
We identified it
Jul 17, 2026
Summary
This is a new South Carolina Medicaid policy defining pharmacogenomics testing as laboratory testing to determine how genetic factors affect medication safety, efficacy, and individual response. The policy establishes the clinical purpose and framework for this testing category but does not provide specific billing codes, coverage criteria, or prior authorization requirements in this summary-only version.
Action Required
Immediately: Billing team must obtain the full policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a57fd87) to identify specific CPT/HCPCS codes, coverage criteria, prior authorization requirements, and effective date. Do not bill pharmacogenomics tests until full policy details are reviewed. Flag all current or pending pharmacogenomics claims for South Carolina Medicaid for review once complete policy is obtained. Contact Humana South Carolina Medicaid for clarification on billing codes and any prior authorization workflows.