Biomarkers Overview
JH · Effective Oct 1, 2015
52 active Medicare policies list 81216, and 9 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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JH · Effective Oct 1, 2015
JL · Effective Oct 1, 2015
J9 · Effective Apr 11, 2016
JH · Effective Dec 1, 2016
JL · Effective Dec 1, 2016
J9 · Effective Jul 17, 2023
JH · Effective Jul 17, 2023
JL · Effective Jul 17, 2023
J15 · Effective Aug 21, 2022
9 policies from 7 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 81216 |
|---|---|---|
| Concert Genetic Testing Oncology: Solid Tumor Molecular Diagnostics | Not recorded | Referenced |
| Concert Genetic Testing: Hereditary Cancer | Not recorded | Referenced |
| Policy | Effective | Status of 81216 |
|---|---|---|
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Preventive Care Services |
JE · Effective Aug 8, 2022
JF · Effective Aug 8, 2022
JJ · Effective Jul 3, 2022
JM · Effective Jul 3, 2022
J5 · Effective Jul 3, 2022
J8 · Effective Jul 3, 2022
J15 · Effective Oct 1, 2015
JE · Effective Oct 1, 2015
JF · Effective Oct 1, 2015
JJ · Effective Oct 1, 2015
JM · Effective Oct 1, 2015
J5 · Effective Feb 16, 2017
J8 · Effective Feb 16, 2017
J15 · Effective Jun 7, 2020
JE · Effective Aug 3, 2020
JF · Effective Aug 3, 2020
JJ · Effective May 31, 2020
JM · Effective May 31, 2020
J5 · Effective Jun 14, 2020
J8 · Effective Jun 14, 2020
J9 · Effective Oct 1, 2015
J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
JL · Effective Oct 1, 2025
J9 · Effective Oct 1, 2025
National · Effective Aug 6, 2026
National · Effective Aug 13, 2026
National · Effective Aug 6, 2026
J5 · Effective Aug 6, 2026
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
J5 · Effective Jul 1, 2026
J5 · Effective Jul 1, 2026
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
JL · Effective Jul 1, 2026
J9 · Effective Jul 1, 2026
J6 · Effective Jul 15, 2026
J9 · Effective Jan 1, 2024
| Sep 1, 2026 |
| Covered |
| Policy | Effective | Status of 81216 |
|---|---|---|
| Genetic Testing | Feb 27, 2024 | Covered |
| Policy | Effective | Status of 81216 |
|---|---|---|
| Hereditary Cancer Testing | Apr 4, 2026 | Covered |
| Policy | Effective | Status of 81216 |
|---|---|---|
| Genetic Testing for Hereditary Cancer | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 81216 |
|---|---|---|
| Genetic Testing for Hereditary Cancer | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 81216 |
|---|---|---|
| Genetic Testing for Hereditary Cancer | Oct 1, 2026 | Covered |