Notification Number: 3598
Effective date: 4/5/2018
Notification date: 1/5/2018
Topic: Genetic testing - CYP2C19, CYP2C9
We will not reimburse for the following genetic testing services because they are not covered.
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.”
Claim edits do not supersede the necessity to obtain preauthorization. Preauthorization requirements are still applicable. Modifiers should be used when appropriate to accurately represent the services rendered. The use of modifiers may impact Humana’s application of these edits. For additional information, consult professional coding resources.
*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.