Medicare AdvantageCoverageHigh impact
Genetic and Coagulation Testing for Noncancer Blood Disorders - Medicare Advantage (Revised)
Humana·Hematology, Genetics, Pathology +2 more·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Aug 12, 2026
Summary
This is a comprehensive Medicare Advantage policy update for genetic and coagulation testing in noncancer blood disorders, effective February 2, 2026. The policy establishes coverage determination criteria, identifies applicable CPT/HCPCS codes, and references multiple MAC-specific Local Coverage Determinations (LCDs) organized by geographic jurisdiction. Billing teams must align claims submission with the appropriate MAC's LCD requirements based on patient location.
Action Required
By February 2, 2026, billing team must: (1) Map all genetic and coagulation testing claims to the appropriate MAC jurisdiction based on patient state; (2) Reference the correct MAC-specific LCD (e.g., MolDX policies for applicable regions) when validating medical necessity and billing codes for Factor V Leiden, Factor II Prothrombin, MTHFR, hemophilia, Fanconi anemia, G6PD deficiency, and hemoglobinopathy testing; (3) Update billing software to route claims to the correct MAC contractor based on geographic jurisdiction listed in policy (J5, J8, J6, JK, J15, JE, JF, JH, JL, JJ, JM, JN); (4) Ensure prior authorization follows the specific MAC's LCD requirements before submitting claims; (5) Train coding and billing staff on which LCD applies to each state/territory served. Claims submitted without adherence to the appropriate MAC's LCD coverage criteria will be denied. Note: The full policy document (24 pages) contains specific codes in the Coverage Determination and Coding Information sections not visible in this excerpt—billing team must access the complete policy via the source URL to identify exact CPT/HCPCS codes for each test category.