MedicaidCoverageMedium impact
Reminder of Florida Medicaid's Reimbursement for Rapid Whole Genome Sequencing
Florida Medicaid·FL · Critical Care, Pediatrics, Pathology·Claims & Billing
Effective date
Jan 1, 2024
We identified it
Jun 16, 2026
Summary
This is a reminder that Florida Medicaid covers rapid whole genome sequencing (CPT codes 81425, 81426, 81427) for patients 20 years or younger with complex illness of unknown cause in ICU settings. Independent laboratories and hospitals can bill these codes with specific fee schedule amounts ranging from $1,262 to $2,717, effective since January 1, 2024.
Action Required
Immediately: Billing team should verify that rapid whole genome sequencing CPT codes 81425, 81426, and 81427 are active in billing system for Florida Medicaid patients meeting criteria (age 20 or younger, complex illness, ICU setting). Hospitals must use revenue code 310 with these CPT codes. Update fee schedules with current rates: 81425 ($2,716.85), 81426 ($1,463.37), 81427 ($1,262.33). No prior authorization required.