MedicaidPrior AuthMedium impact
Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - OHIO (New)
Humana·OH · Hematology, Oncology, Pathology·Medicaid
Effective date
Jan 7, 2026
We identified it
Jun 24, 2026
Summary
Humana Healthy Horizons in Ohio (Medicaid) has established a new policy covering comprehensive genomic profiling and molecular biomarker testing for cancer, including specific tests for hematologic malignancies and suspected myeloid disorders. The policy requires prior authorization for covered genomic testing services and outlines specific medical necessity criteria for approval.
Action Required
Before January 7, 2026: Billing team must update prior authorization workflows for CPT codes 81450, 81455, and 81456 when billing Humana Healthy Horizons Ohio Medicaid. Update billing system to flag these genomic testing codes for prior auth requirements. Providers must submit medical necessity documentation including diagnosis of AML, MDS, MPNs, suspected myeloid malignancy with undefined cytopenia >4 months, or systemic mastocytosis. Claims without prior authorization may be subject to denial or retrospective review.