← Back to list
Gene Expression Profiling for Cancer Indications - MEDICAID - FLORIDA (New)
Effective date
Jun 3, 2025
Identified
Jun 24, 2026
Summary
Humana Florida Medicaid has established a new gene expression profiling policy covering only ConfirmMDx testing for prostate cancer management under specific clinical conditions. Multiple other gene expression profiling tests for various cancers (bladder, breast, lung, colorectal, etc.) are explicitly excluded from coverage due to insufficient evidence.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
Action · 3 steps
01Before June 3, 2025: Billing team must update Florida Medicaid billing rules to only allow CPT 81551 (ConfirmMDx) for prostate cancer cases meeting specific criteria (atypia suspicious for cancer, benign with clinical suspicion, or high-grade PIN).
02Block all other gene expression profiling codes listed in the exclusions.
03Update prior authorization workflows to verify clinical indications for ConfirmMDx testing.
Codes mentioned
8155181540
Original notice
Gene Expression Profiling for Cancer Indications - MEDICAID - FLORIDA (New)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Gene Expression Profiling for Cancer Indications - MEDICAID - VIRGINIA (Revised)MediumEffective Apr 8, 2026 · MedicaidGene Expression Profiling for Cancer Indications - MEDICAID - SOUTH CAROLINA (Revised)MediumEffective Apr 8, 2026 · MedicaidGene Expression Profiling for Cancer Indications - MEDICAID - MICHIGAN (New)MediumEffective Apr 8, 2026 · MedicaidGene Expression Profiling for Cancer Indications - MEDICAID - INDIANA (New)MediumEffective Jun 3, 2025 · MedicaidBrowse every Humana change in the policy list