MedicaidCoverageMedium impact
Gene Expression Profiling for Cancer Indications - MEDICAID - VIRGINIA (Revised)
Humana·VA · Oncology, Urology, Pathology·Medicaid
Effective date
Apr 8, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid in Virginia has updated coverage policies for gene expression profiling tests for cancer. ConfirmMDx (81551) is covered for specific prostate cancer indications, while multiple other gene expression tests including bladder cancer, lymphoma, and other cancer screening tests are explicitly non-covered.
Action Required
Before April 8, 2026: Billing team must update prior authorization systems to allow ConfirmMDx (81551) for Virginia Medicaid members with specific prostate cancer indications (atypia suspicious for cancer, benign but clinical suspicion persists, or high-grade PIN). Update billing software to flag and deny the 24 non-covered gene expression profiling codes listed in the policy for Virginia Medicaid claims to prevent claim denials.