Biomarkers Overview
JH · Effective Oct 1, 2015
71 active Medicare policies list 81401, and 42 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 Jan 30, 2022
JH · Effective Jan 30, 2022
JL · Effective Jan 30, 2022
J9 · Effective Jul 17, 2023
JH · Effective Jul 17, 2023
JL · Effective Jul 17, 2023
J15 · Effective Dec 26, 2021
42 policies from 10 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Showing 10 of 13 · All Ambetter policies
| Policy | Effective | Status of 81401 |
|---|---|---|
| Concert Genetic Testing: Cardiovascular | Not recorded | Referenced |
| Concert Genetic Testing: Gastroenterology | Not recorded | Referenced |
| Concert Genetic Testing: Hematology | Not recorded | Referenced |
| Concert Genetic Testing: Hereditary Cancer | Not recorded | Referenced |
| Concert Genetic Testing: Immunology and Rheumatology |
JE · Effective Jan 2, 2022
JF · Effective Jan 2, 2022
JJ · Effective Dec 26, 2021
JM · Effective Dec 26, 2021
J5 · Effective Dec 26, 2021
J8 · Effective Dec 26, 2021
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 Aug 3, 2020
JE · Effective Aug 17, 2020
JF · Effective Aug 17, 2020
JJ · Effective Jul 26, 2020
JM · Effective Jul 26, 2020
J5 · Effective Jul 26, 2020
J8 · Effective Jul 26, 2020
J15 · Effective Jul 18, 2021
JE · Effective Jul 25, 2021
JF · Effective Jul 25, 2021
JJ · Effective Jul 18, 2021
JM · Effective Jul 18, 2021
J5 · Effective Jul 18, 2021
J8 · Effective Jul 18, 2021
J9 · Effective Oct 1, 2015
J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
J6 · Effective Jul 13, 2025
JK · Effective Jul 13, 2025
J9 · Effective Dec 12, 2021
JH · Effective Dec 12, 2021
JL · Effective Dec 12, 2021
JL · Effective Jan 1, 2025
J9 · Effective Jan 1, 2025
National · Effective Apr 24, 2025
National · Effective Feb 5, 2026
National · Effective Apr 24, 2025
J5 · Effective Apr 24, 2025
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
J5 · Effective Jul 1, 2026
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
National · Effective Nov 13, 2025
J5 · Effective Jul 1, 2026
National · Effective Jan 1, 2024
National · Effective Jan 1, 2024
National · Effective Feb 5, 2026
J5 · Effective Jan 1, 2024
JL · Effective Jul 1, 2026
J9 · Effective Jul 1, 2026
J6 · Effective Jul 15, 2026
J9 · Effective Jan 1, 2024
J6 · Effective Apr 1, 2026
JL · Effective Sep 10, 2026
J9 · Effective Sep 10, 2026
| Not recorded |
| Referenced |
| Concert Genetic Testing: Multisystem Genetic Conditions | Not recorded | Referenced |
|---|
| Concert Genetic Testing: Nephrology | Not recorded | Referenced |
|---|
| Concert Genetic Testing: Neurology | Not recorded | Referenced |
|---|
| Concert Genetic Testing: Nutrition and Metabolism | Not recorded | Referenced |
|---|
| Concert Genetic Testing: Orthopedics | Not recorded | Referenced |
|---|
| Policy | Effective | Status of 81401 |
|---|---|---|
| Apolipoprotein E for Risk Assessment and Management of Cardiovascular Disease | Apr 1, 2026 | Covered |
| Expanded Molecular Testing of Cancers to Select Targeted Therapies | Jul 1, 2026 | Covered |
| Genetic Testing for Alzheimer's Disease | Jun 1, 2026 | Covered |
| Genetic Testing for Epilepsy | Jan 1, 2026 | Covered |
| Genetic Testing for Familial Hypercholesterolemia | Mar 1, 2026 | Covered |
| Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Feb 1, 2026 | Covered |
| Genetic Testing for Macular Degeneration | Oct 1, 2025 | Covered |
| Genetic Testing for Myeloid Neoplasms and Leukemia | Jun 1, 2026 | Covered |
| Genetic Testing for Primary Mitochondrial Disorders | Mar 1, 2026 | Covered |
| Reproductive Carrier Screening for Genetic Diseases | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 81401 |
|---|---|---|
| Alzheimer's Disease Tests | Sep 8, 2023 | Covered |
| Fetal Fibronectin, Inflammatory Biomarkers, and Salivary Hormone Testing for Preterm Labor | Apr 6, 2023 | Covered |
| Huntington's Disease | Sep 12, 2023 | Covered |
| Pharmacogenetic and Pharmacodynamic Testing | Feb 27, 2024 | Covered |
| Recurrent Pregnancy Loss | Feb 15, 2024 | Covered |
| Tumor Markers | Mar 5, 2024 | Covered |
| Policy | Effective | Status of 81401 |
|---|---|---|
| Carrier Screening in the Reproductive Setting | Sep 19, 2026 | Covered |
| Carrier Screening in the Reproductive Setting | Sep 20, 2025 | Covered |
| Hereditary Cancer Testing | Apr 4, 2026 | Covered |
| Pharmacogenetic Testing | Jun 14, 2026 | Covered |
| Predictive and Prognostic Polygenic Testing | Jun 14, 2026 | Covered |
| Policy | Effective | Status of 81401 |
|---|---|---|
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Molecular and Proteomic Diagnostic Testing for Hematology and Oncology Indications | Sep 13, 2026 | Covered |
| Pharmacogenetic Testing | Jul 15, 2026 | Covered |
| Policy | Effective | Status of 81401 |
|---|---|---|
| Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease | Jul 15, 2026 | Covered |
| Policy | Effective | Status of 81401 |
|---|---|---|
| Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease | Jul 15, 2026 | Covered |
| Policy | Effective | Status of 81401 |
|---|---|---|
| Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease | Jul 15, 2026 | Covered |
| Policy | Effective | Status of 81401 |
|---|---|---|
| Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease | Jul 15, 2026 | Covered |
| Policy | Effective | Status of 81401 |
|---|---|---|
| Tier 2 Molecular Pathology Procedures | Not recorded | Covered |