Medicare AdvantageCoverageMedium impact
Pharmacogenomics Testing - Medicare Advantage (Revised)
Humana·Pharmacy, Internal Medicine, Cardiology +2 more·Pharmacy
We identified it
Aug 4, 2026
Summary
This is a new Medicare Advantage policy defining pharmacogenomics testing coverage. The policy establishes that genetic testing to predict drug response, determine appropriate dosing, and identify drug resistance is now a covered service. Billing teams must identify applicable pharmacogenomics CPT/HCPCS codes and ensure claims align with this coverage definition.
Action Required
Immediately: Billing team must obtain the complete policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a591cb2) to extract specific CPT and HCPCS codes covered under pharmacogenomics testing. Update billing system to recognize pharmacogenomics testing claims as covered services for Medicare Advantage members. Add coverage indicator to encounter forms for providers ordering genetic testing. Document the effective date once the full policy is reviewed. Without complete policy details, claims may be incorrectly denied or delayed.