Pharmacogenomics Testing - Medicare Advantage

This Humana Medicare Advantage policy follows CMS NCDs/LCDs/LCAs and MolDX/FDA determinations: pharmacogenomic MDTs/LDTs are covered when identified as covered by applicable NCDs/LCDs/LCAs or, in jurisdictions without CMS guidance, when supported by MolDX technical assessment or FDA approval within labeling and demonstrated clinical utility. Specific coverage includes CYP27A1 testing for diagnosis of CTX when hallmark clinical manifestations are present and warfarin pharmacogenomic testing per NCD 90.1; statutory exclusions (eg, screening, investigational tests not in trials) and requirements that tests be ordered by the treating physician and used to manage a specific medical problem apply.

"Medicare-covered MDTs and LDTs that are identified as covered in an NCD, LCD or LCA when medical necessity criteria are met."

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