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Gene Expression Profiling for Cancer Indications - MEDICAID - SOUTH CAROLINA (Revised)
Effective date
Apr 8, 2026
Identified
Jun 24, 2026
Summary
Humana South Carolina Medicaid has updated their gene expression profiling policy, providing limited coverage for ConfirmMDx prostate cancer testing under specific clinical conditions while explicitly excluding numerous other gene expression profiling tests. The policy clarifies that most gene expression profiling tests are not covered due to insufficient evidence.
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What to do
Action · 4 steps
01Before April 8, 2026: Update billing system to flag South Carolina Medicaid patients for gene expression profiling tests.
02Configure system to allow CPT 81551 (ConfirmMDx) only for prostate cases with atypia, benign with clinical suspicion, or high-grade PIN.
03Set all other listed gene expression profiling codes to deny for SC Medicaid.
04Train billing team on new coverage limitations to prevent claim denials.
Codes mentioned
8155181540
Original notice
Gene Expression Profiling for Cancer Indications - MEDICAID - SOUTH CAROLINA (Revised)
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 - MICHIGAN (New)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