MedicaidCoverageMedium impact
Gene Expression Profiling for Cancer Indications - MEDICAID - OHIO (New)
Humana·OH · Oncology, Urology, Pathology·Medicaid
Effective date
Apr 13, 2026
We identified it
Jun 24, 2026
Summary
New Ohio Medicaid policy establishes coverage for specific gene expression profiling tests for cancer, covering ConfirmMDx for prostate cancer management and DecisionDx-UM for uveal melanoma risk stratification, while explicitly excluding three other GEP tests due to insufficient evidence.
Action Required
Before April 13, 2026: Billing team must update prior authorization processes for Ohio Medicaid members requiring gene expression profiling tests. Ensure CPT 81551 (ConfirmMDx) and 81552 (DecisionDx-UM) meet specific clinical criteria before submission. Flag CPT 81529, 0047U, and 0090U as non-covered for Ohio Medicaid and inform providers these will be denied. Update billing system to reflect coverage limitations.