MedicaidCoverageMedium impact
Gene Expression Profiling for Cancer Indications - MEDICAID - INDIANA (New)
Humana·IN · Oncology, Urology·Medicaid
Effective date
Jun 3, 2025
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has established a new policy for gene expression profiling cancer tests, covering only ConfirmMDx (81551) for specific prostate cancer indications while excluding numerous other GEP tests including bladder, breast, and other cancer screenings due to insufficient evidence.
Action Required
Before June 3, 2025: Billing team must update system to only allow CPT 81551 (ConfirmMDx) for Indiana Medicaid members with prostate cancer atypia, benign with clinical suspicion, or high-grade PIN. Block all other listed GEP test codes for this payer as they are not covered. Update encounter forms to alert providers of coverage restrictions for gene expression profiling tests.