MedicaidCoverageMedium impact
Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - MICHIGAN (New)
Humana·MI · Genetics, Neurology, Ophthalmology +2 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Michigan Medicaid (Humana) is implementing a new policy for genetic testing coverage for inherited conditions including CANVAS, corneal dystrophy, DRPLA, glycogen storage disease, and other genetic disorders. The policy establishes specific coverage criteria requiring pre- and post-test genetic counseling and detailed clinical documentation for various genetic tests.
Action Required
Before January 1, 2026: Billing team must update prior authorization requirements for genetic testing codes 0378U and 81333 for Michigan Medicaid patients. Ensure pre- and post-test genetic counseling documentation is obtained and clinical criteria are met before submitting claims. Update encounter forms to include genetic counseling requirements and age/symptom criteria for CANVAS testing (age 35+ with specific neurological symptoms).