Billing and Coding: Pharmacogenomics Testing

Medicare covers germline pharmacogenomic testing when results have established clinical utility to guide a beneficiary's drug therapy and when billing and documentation requirements are met. Duplicate testing of identical germline content in the same beneficiary is not covered, CPT 81418 panels must include at least six genes (including CYP2C19 and CYP2D6 with CYP2D6 CNV analysis), and specific claim-level gene listing and drug information must be submitted per Part A/B claim instructions.

"Germline pharmacogenomic (PGx) testing is covered when the test results have established clinical utility to guide management of a specific drug therapy for the Medicare beneficiary."

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