MedicaidCoverageMedium impact
Gene Expression Profiling for Cancer Indications - MEDICAID - MICHIGAN (New)
Humana·MI · Oncology, Urology·Medicaid
Effective date
Apr 8, 2026
We identified it
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.
Action Required
By April 8, 2026: Billing 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. Configure 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.