MedicaidCoverageMedium impact
22-095 Rapid Whole Genome Sequencing Codes Are Now A Covered Benefit
Health Net·CA · Pediatrics, Critical Care·Reimbursement
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Rapid whole genome sequencing (rWGS) codes 0094U, 0212U, 0213U, and 81425-81427 are now covered benefits for Medi-Cal beneficiaries 1 year old or younger receiving inpatient ICU services. These codes are effective for outpatient billing only, as inpatient laboratory services remain bundled under DRG or per diem payment.
Action Required
Immediately: Billing team must update billing system to allow coverage for CPT codes 0094U, 0212U, 0213U, and 81425-81427 for Medi-Cal patients aged 1 year or younger receiving outpatient services. Ensure these codes are NOT used for inpatient billing as laboratory services remain bundled under DRG/per diem payment.