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Gene Expression Profiling for Cancer Indications - MEDICAID - MICHIGAN (New)
Act
by Apr 8, 2026
Effective date
Apr 8, 2026
Identified
Jun 24, 2026
Summary
New Humana Medicaid policy establishes coverage for ConfirmMDx gene expression profiling test (CPT 81551) for specific prostate cancer indications, while explicitly excluding coverage for numerous other gene expression profiling tests across various cancer types. The policy becomes effective April 8, 2026 for Michigan Medicaid members.
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What to do
by Apr 8, 2026 · 2 steps
01Billing team must update system to allow CPT 81551 (ConfirmMDx) for Michigan Humana Medicaid when patients have atypia suspicious for cancer, benign results with persistent clinical suspicion, or high-grade PIN.
02Configure system to deny all listed gene expression profiling codes (0549U, 81540, 0012M, 0013M, 0363U, 0420U, 0016M, 0315U, 0288U, 0452U, 0313U, 0510U, 0067U, 0296U, 0019U, 0020M, 0153U, 0017M, 0120U, 0069U, 0262U, 0534U, 0465U) as non-covered services for Michigan Medicaid.
Codes mentioned
8155181540
Original notice
Gene Expression Profiling for Cancer Indications - MEDICAID - MICHIGAN (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 - INDIANA (New)MediumEffective Jun 3, 2025 · MedicaidGene Expression Profiling for Cancer Indications - MEDICAID - FLORIDA (New)MediumEffective Jun 3, 2025 · MedicaidBrowse every Humana change in the policy list