Medicare AdvantageCoverageMedium impact
Gene Expression Profiling for Noncancer Indications - Medicare Advantage (Revised)
Humana·Oncology, Pathology, Genetics +1 more·Medicare Advantage
We identified it
Aug 4, 2026
Summary
This is a new Medicare Advantage policy on Gene Expression Profiling (GEP) for noncancer indications. The policy defines GEP as laboratory testing that measures RNA activity across hundreds to thousands of genes using methodologies such as microarray technology, next-generation sequencing, and whole transcriptome sequencing. The billing team must review coverage criteria, medical necessity requirements, and any prior authorization mandates once the full policy details are available.
Action Required
Immediately: Obtain and review the complete policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a59069d) as only a summary excerpt is currently available. Billing team must identify: (1) specific CPT/HCPCS codes affected by this policy, (2) coverage limitations for noncancer GEP testing, (3) prior authorization requirements, and (4) medical necessity documentation standards. Once full policy details are received, update billing system rules, encounter forms, and provider guidance accordingly. Flag any claims for GEP noncancer testing pending full policy clarification to avoid denials.