MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - VIRGINIA (Revised)
Humana·VA · Genetics, Pharmacy, Internal Medicine +2 more·Medicaid
We identified it
Jul 21, 2026
Summary
Virginia Medicaid has issued a revised policy on pharmacogenomics testing, which is laboratory testing that determines how an individual's genetic factors may affect medication safety, effectiveness, and treatment response. The billing team must verify coverage criteria, prior authorization requirements, and applicable billing codes for pharmacogenomics testing claims under Virginia Medicaid, as this is a newly updated policy (1 day old) requiring immediate review.
Action Required
Immediately: Billing and clinical teams must review the complete Virginia Medicaid pharmacogenomics testing policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a584524 to identify: (1) specific CPT/HCPCS codes covered under this revised policy, (2) prior authorization requirements, (3) medical necessity documentation requirements, and (4) any coverage limitations or exclusions. Update billing system rules and encounter templates accordingly. Contact Humana Virginia Medicaid directly if coverage details or specific billing codes are not provided in the policy summary. Do not bill pharmacogenomics testing under Virginia Medicaid until coverage parameters and required codes are confirmed, as claims may otherwise be denied.