MedicaidPrior AuthMedium impact
Florida Medicaid's Rapid Whole Genome Sequencing (RWGS) Billing Guidance Webpage
Florida Medicaid·FL · Pediatrics, Critical Care·Claims & Billing
Effective date
Jan 1, 2024
We identified it
Jun 16, 2026
Summary
Florida Medicaid has updated billing guidance for Rapid Whole Genome Sequencing (RWGS) for children under 21 in pediatric ICUs. Prior authorization requirements have been waived for SMMC health plans, and hospital providers will receive additional reimbursement on top of DRG payments.
Action Required
Immediately: Billing teams at hospitals with pediatric ICUs should review the updated RWGS billing guidance webpage and individual SMMC plan billing requirements. Verify that prior authorization is not being requested for RWGS services for children under 21. Update billing workflows to ensure additional maximum fee schedule amounts are billed in addition to DRG payments for qualifying RWGS cases.