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AetnaAll Plans · Coverage · Medical Policy · Oncology, Genetics, Pharmacy +7 moreMedium impact

Pharmacogenetic and Pharmacodynamic Testing (CPB 0715, reviewed 2026-10-08)

Effective date
Not stated in the notice
Identified
Oct 16, 2026

Summary

Aetna Clinical Policy Bulletin 0715 covers pharmacogenetic and pharmacodynamic testing and lists the tests Aetna considers medically necessary, along with the indications that qualify for each. Examples include ALK fusion testing for members considering crizotinib, alectinib or ceritinib for non-small cell lung cancer, BRCA testing for members considering olaparib, and CYP2C19 genotyping for members who have been prescribed clopidogrel. Multi-gene pharmacogenetics panels are considered experimental, investigational, or unproven, and Aetna considers several FoundationOne, Guardant360 CDx and oncoReveal panels not medically necessary for specific indications because there is no proven advantage over targeted mutation testing or small targeted panels for those indications.

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What to do

Action · 4 steps
01Billing team: before billing any test in this policy, confirm that the member's indication matches the listed criteria, because the listed codes are covered only if the selection criteria are met.
02For ctDNA MRD testing (e.g., Signatera) in muscle invasive bladder cancer, the criteria are radical cystectomy with curative intent, initial testing no earlier than 6 weeks after cystectomy, repeat testing no more frequently than every 6 weeks when medically indicated, results intended to inform consideration of adjuvant atezolizumab (Tecentriq) therapy, and testing limited to the first 12 months following cystectomy.
03Do not bill repeat CYP2C19 or CYP2D6 genotyping, since the policy states repeat genotyping has no proven value.
04Check the indication before billing FoundationOne, Guardant360 CDx or oncoReveal testing for the indications where the policy considers them not medically necessary.

Codes mentioned

82726812258122681227812328135081381812108123581275812768131181401812458124681120811218128783789883608836181301814048827188275

Original notice

Pharmacogenetic and Pharmacodynamic Testing (CPB 0715, reviewed 2026-10-08)
aetna.com · Always check the source before changing claims.
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