Biomarkers Overview
JH · Effective Oct 1, 2015
29 active Medicare policies list 81416, and 11 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 Oct 1, 2015
11 policies from 6 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 81416 |
|---|---|---|
| Concert Genetic Testing Oncology: Solid Tumor Molecular Diagnostics | Not recorded | Referenced |
| Concert Genetic Testing: Multisystem Genetic Conditions | Not recorded | Referenced |
| Concert Genetic Testing: Prenatal Diagnosis | Not recorded | Referenced |
| Policy | Effective | Status of 81416 |
|---|---|---|
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
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
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
National · Effective Jul 1, 2026
J5 · Effective Jul 1, 2026
JL · Effective Jul 1, 2026
J9 · Effective Jul 1, 2026
J6 · Effective Jul 15, 2026
| Genetic Testing for Hereditary Cancer |
|---|
| Oct 1, 2026 |
| Covered |
| Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) – Surest Medical Policy | Oct 1, 2026 | Covered |
|---|
| Policy | Effective | Status of 81416 |
|---|---|---|
| Genetic Testing for Hereditary Cancer | Oct 1, 2026 | Covered |
| Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 81416 |
|---|---|---|
| Genetic Testing for Hereditary Cancer | Oct 1, 2026 | Covered |
| Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 81416 |
|---|---|---|
| Whole Exome Sequencing and Whole Genome Sequencing | Jun 14, 2026 | Covered |
| Policy | Effective | Status of 81416 |
|---|---|---|
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |