Pharmacogenetic Testing - (0500)

Cigna covers pharmacogenetic testing only when it is used to guide a specific targeted drug therapy tied to a defined gene biomarker (and is excluded for general population screening, gene‑expression classifiers for drug response, many proprietary multigene/combinatorial panels and numerous listed not‑reimbursable CPT/proprietary codes; oncologic/hematologic indications are covered under separate policies). Key requirements: the patient must be a candidate for the drug, results must directly affect clinical management, the test method must be scientifically valid and either shown to improve outcomes or mandated by the FDA label, and testing must be done in a CLIA‑certified high‑complexity lab following CAP guidance with appropriate documentation and covered diagnosis/procedure codes.

"Pharmacogenetic testing (e."

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