Cytochrome P450 (CYP450) genotyping for the purpose of aiding in the choice of clopidogrel versus alternative antiplatelet agents, or in decisions on the optimal dosing for clopidogrel, is considered investigational.
CYP2D6 genotyping to determine drug metabolizer status may be considered medically necessary for individuals :
With Gaucher disease being considered for treatment with eliglustat; OR
With Huntington disease being considered for treatment with tetrabenazine in a dosage greater than 50 mg per day
CYP2C9 genotyping to determine drug metabolizer status may be considered medically necessary for individuals:
With relapsing forms of multiple sclerosis, to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, being considered for treatment with siponimod.
CYP450 genotyping for the purpose of aiding in the choice of drug or dose to increase efficacy and/or avoid toxicity for the following drugs is considered investigational, aside from determinations in the separate related policies noted above:
selection or dosage of codeine
dosing of efavirenz and other antiretroviral therapies for HIV infection
dosing of immunosuppressants for organ transplantation
selection or dosing of β-blockers (eg, metoprolol)
dosing and management of antitubercular medications.
The use of genetic testing panels that include multiple CYP450 variants is considered investigational.
