Biomarkers Overview
JH · Effective Oct 1, 2015
63 active Medicare policies list 81403, and 33 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 Nov 1, 2020
33 policies from 7 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Showing 10 of 14 · All Ambetter policies
| Policy | Effective | Status of 81403 |
|---|---|---|
| Concert Genetic Testing: Cardiovascular | Not recorded | Referenced |
| Concert Genetic Testing: Endocrinology | 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 Dec 6, 2020
JF · Effective Dec 6, 2020
JJ · Effective Oct 25, 2020
JM · Effective Oct 25, 2020
J5 · Effective Oct 25, 2020
J8 · Effective Oct 25, 2020
J15 · Effective Aug 21, 2022
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 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
JL · Effective Jan 1, 2025
J9 · Effective Jan 1, 2025
J5 · Effective Oct 1, 2024
National · Effective Jan 22, 2026
National · Effective Oct 1, 2024
National · Effective Oct 1, 2024
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
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
| 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 81403 |
|---|---|---|
| Expanded Molecular Testing of Cancers to Select Targeted Therapies | Jul 1, 2026 | Covered |
| Fetal Red Blood Cell Antigen Genotyping Using Maternal Plasma | Jul 1, 2026 | Covered |
| Genetic Testing for Epilepsy | Jan 1, 2026 | Covered |
| Genetic Testing for Myeloid Neoplasms and Leukemia | Jun 1, 2026 | Covered |
| Genetic Testing for Primary Mitochondrial Disorders | Mar 1, 2026 | Covered |
| Genetic Testing for the Diagnosis of Inherited Peripheral Neurophathies | May 1, 2026 | Covered |
| KRAS, NRAS, and BRAF Variant Analysis and MicroRNA Expression Testing for Colorectal Cancer | Apr 1, 2026 | Covered |
| Reproductive Carrier Screening for Genetic Diseases | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 81403 |
|---|---|---|
| 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 |
| Predictive and Prognostic Polygenic Testing | Jun 14, 2026 | Covered |
| Prenatal Screening Using Cell Free Dna | Sep 19, 2026 | Covered |
| Prenatal Screening Using Cell Free Dna | Sep 20, 2025 | Covered |
| Policy | Effective | Status of 81403 |
|---|---|---|
| Genetic Testing for Hematologic Malignancies and Suspected Myeloid Disorders | Sep 1, 2026 | Covered |
| Genetic Testing for Hereditary Colorectal and Uterine Cancer | Apr 1, 2026 | Covered |
| Policy | Effective | Status of 81403 |
|---|---|---|
| Eating Disorders | Aug 1, 2023 | Covered |
| Policy | Effective | Status of 81403 |
|---|---|---|
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 81403 |
|---|---|---|
| Tier 2 Molecular Pathology Procedures | Not recorded | Covered |