MedicaidCoverageMedium impact
Breast Cancer Gene Expression Profiling
Alaska Medicaid·AK · Oncology·Program Update
Effective date
Nov 5, 2022
We identified it
Jun 21, 2026
Summary
Alaska Medicaid updated coverage criteria for breast cancer gene expression profiling effective November 5, 2022. CPT 81519 has revised medical necessity requirements, while CPT 81522 coverage ends completely. Both codes require specific documentation including a Genetic Testing Supporting Information form and lab report.
Action Required
Immediately: Update billing system to reflect that CPT 81522 is no longer covered by Alaska Medicaid as of November 5, 2022. For CPT 81519, ensure all claims include required documentation: Genetic Testing Supporting Information form and lab report. Verify all medical necessity criteria are met before billing, including oncologist ordering requirement and NCCN guideline compliance. Claims without proper documentation will be denied.