MedicaidCoverageMedium impact
MSA 21-33
Michigan Medicaid - MDHHS·MI · Pediatrics, Genetics, Critical Care·Provider Bulletin
Effective date
Sep 1, 2021
We identified it
Jun 20, 2026
Summary
Michigan Medicaid now covers Rapid Whole Genome Sequencing (rWGS) testing for critically ill infants under 1 year in ICUs, with separate reimbursement outside DRG payments. Hospitals must obtain prior authorization within 30 days of service and bill using specific CPT codes with detailed clinical criteria documentation.
Action Required
Immediately: Billing teams at Michigan hospitals must update systems to recognize new rWGS coverage for infants under 1 year in ICUs. Implement prior authorization workflow using form MSA-2081 within 30 days of service. Configure billing system to use CPT codes 81425, 81426, or 0094U with place of service 21. Train staff on medical necessity criteria and required provider documentation. Set up separate 837P/CMS-1500 billing process outside normal DRG claims. Failure to obtain authorization within 30 days will result in no separate reimbursement.