MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - INDIANA (Revised)
Humana·IN · Cardiology, Endocrinology, Family Medicine +7 more·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 17, 2026
Summary
Humana Indiana Medicaid updated its pharmacogenomics testing coverage policy effective 07/22/2026. The policy covers molecular pathology testing (CPT 81479) for pharmacogenomics analysis when treating with medications having known gene-drug interactions per FDA labeling or CPIC guidelines (Level A or B), and covers SLCO1B1 genotype testing (CPT 81328) for statin-induced myopathy risk assessment. For members under age 21, testing requires medical necessity review under EPSDT requirements.
Action Required
By 07/22/2026: Billing team must update claims processing system to recognize CPT 81328 and 81479 as covered services under Indiana Medicaid when appropriate clinical criteria are met. Update prior authorization workflows to require medical necessity documentation for CPT 81479 claims (gene-drug interaction per FDA labeling or CPIC Level A/B). For members under 21, ensure EPSDT medical necessity review is triggered in system. Update provider billing guidance and encounter forms to clarify coverage criteria. Coordinate with providers to document FDA-labeled or CPIC-guideline gene-drug interactions on test requisitions. Test claims without appropriate documentation of covered drug-gene interactions will be denied.