Biomarkers Overview
JH · Effective Oct 1, 2015
36 active Medicare policies list 81243, 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 Jul 17, 2023
JH · Effective Jul 17, 2023
JL · Effective Jul 17, 2023
J15 · Effective Oct 1, 2015
JE · Effective Oct 1, 2015
JF · Effective Oct 1, 2015
JJ · Effective Oct 1, 2015
9 policies from 3 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 81243 |
|---|---|---|
| Carrier Screening in the Reproductive Setting | Sep 19, 2026 | Covered |
| Carrier Screening in the Reproductive Setting | Sep 20, 2025 | Covered |
| Genetic Testing for Inherited Conditions | Sep 19, 2026 | Covered |
| Genetic Testing for Inherited Conditions | Sep 20, 2025 | Covered |
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
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
| Policy | Effective | Status of 81243 |
|---|---|---|
| Concert Genetic Testing: Multisystem Genetic Conditions | Not recorded | Referenced |
| Concert Genetic Testing: Prenatal and Preconception Carrier Screening | Not recorded | Referenced |
| Concert Genetic Testing: Prenatal Diagnosis | Not recorded | Referenced |
| Policy | Effective | Status of 81243 |
|---|---|---|
| Diagnostic Genetic Testing for FMR1 and AFF2 Variants (including Fragile X and Fragile XE Syndromes) | Jun 1, 2026 | Covered |
| Reproductive Carrier Screening for Genetic Diseases | Dec 1, 2025 | Covered |