MedicaidCoverageLow impact
Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - INDIANA (Revised)
Humana·IN · Genetics, Hematology, Neurology +1 more·Medicaid
Effective date
Apr 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has established new genetic testing coverage criteria for three inherited conditions: Hemophilia B, Myotonic Dystrophy Types 1 & 2, and Tay-Sachs disease. The policy requires pre- and post-test genetic counseling and specifies detailed clinical criteria for coverage approval.
Action Required
By April 1, 2025: Billing team must update prior authorization procedures for CPT 81238, 83080, and HCPCS S3853 when billing Indiana Medicaid. Ensure documentation includes required pre/post genetic counseling and specific clinical criteria outlined in the policy. Providers must verify patients meet eligibility requirements before ordering tests to avoid claim denials.