MedicaidCoverageMedium impact
22-096 Rapid Whole Genome Sequencing Codes Are Now A Covered Benefit
Health Net·CA · Critical Care, Pediatrics·Reimbursement
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Rapid whole genome sequencing (rWGS) is now a covered benefit for Medi-Cal patients 1 year or younger receiving inpatient ICU services in Fresno, Kings and Madera counties. Seven specific CPT codes are now covered, but these codes cannot be used for inpatient billing as lab services are bundled under DRG or per diem payments.
Action Required
Immediately: Billing team must update system to recognize CPT codes 0094U, 0212U, 0213U, 81425, 81426, and 81427 as covered for Medi-Cal patients 1 year or younger in ICU settings in Fresno, Kings and Madera counties. Important: Do not use these codes for inpatient billing as laboratory services are bundled under DRG/per diem payments. Update encounter forms and train staff on age and geographic restrictions.