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BT2024126: IHCP announces expanded coverage of biomarker testing
Effective date
Jul 1, 2024
Identified
Jun 19, 2026
Summary
In accordance with Senate Enrolled Act 273, the IHCP expanded coverage for biomarker testing for dates of service on or after July 1, 2024. Table 1 lists the newly covered biomarker testing codes, and some of those codes require prior authorization.
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What to do
Action · 4 steps
01Already effective July 1, 2024: For the codes in Table 1 marked PA required Yes, obtain prior authorization.
02Biomarker testing is a covered benefit when supported by medical evidence, including FDA labeled indications for a test, indicated tests for an FDA approved drug, an FDA drug label warning or precaution about a specific genetic makeup, a CMS national coverage determination, a Medicare administrative contractor local coverage determination, or nationally recognized clinical practice guidelines or consensus statements.
03Screening is not covered unless there is evidence of high risk to the member and a screening may be appropriate to inform the plan of care.
04Tests that are not FDA approved or supported by nationally recognized clinical practice guidelines are not covered benefits, and tests that do not have a Medicare fee schedule are not covered benefits.
Codes mentioned
81105811068110781108811098111081111811128117081178811798118081181811828118381184811858118681191811928119381194812058120981210812218122281223812248122581226812278124081241812428124781248812498125681260812718127281273812748127581284812858128681289812908131481324813258132681331813328133681337813398134081341813428134381344813498135181352813538135581362813638137381374813768138081381813828138381400814018140281406814088141081411814128141381414814158141681417814258142681427814308143181432814338143481435814368143781438814418144281443814458144881449814518145681460814658151781518815208152181523815398159587523G9143
Original notice
BT2024126: IHCP announces expanded coverage of biomarker testing
in.gov · Always check the source before changing claims.
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