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Code edit notification

Notification Number: 3598

Effective date: 4/5/2018

Notification date: 1/5/2018

Category: CPT

Topic: Genetic testing - CYP2C19, CYP2C9

Providers affected:

  • Inpatient/Outpatient Facilities
  • Physician/Health Care Providers
What is changing?

We will not reimburse for the following genetic testing services because they are not covered.

  • CPT code 81225 – CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19; e.g., drug metabolism), gene analysis, common variants (e.g., *2, *3, *4, *8, *17)
  • CPT code 81227 – CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9; e.g., drug metabolism), gene analysis, common variants (e.g., *2, *3, *5, *6)
Why is Humana implementing this change?

Humana's policy concerning genetic testing for diagnosis and monitoring of noncancer indications has been updated to indicate that the services listed above are not covered because they are considered experimental/investigational. Nationally recognized peer-reviewed literature does not identify them as widely used and generally accepted for the proposed uses.

For more information, refer to Humana's Medical and Pharmacy Coverage Policies page and search by keyword using either “81225” or “81227.”

Impacted products

  • Commercial fully insured products

Disclaimer

*All edits previously posted on Humana.com/providers for fully insured commercial Humana members may be applied to self-funded members, when requested by the self-funded group.