MedicaidCoverageMedium impact
Gene Expression Profiling for Cancer Indications - MEDICAID - FLORIDA (New)
Humana·FL · Oncology, Urology, Pathology·Medicaid
Effective date
Jun 3, 2025
We identified it
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.
Action Required
Before 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). Block all other gene expression profiling codes listed in the exclusions. Update prior authorization workflows to verify clinical indications for ConfirmMDx testing.