MedicaidCoverageMedium impact
Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - SOUTH CAROLINA (New)
Humana·SC · Oncology, Hematology, Genetics·Medicaid
Effective date
Sep 3, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new Medicaid policy for South Carolina that explicitly does NOT cover several genomic and molecular biomarker tests for cancer, including concurrent DNA/RNA genetic testing and various comprehensive genomic profiling tests. The policy lists specific CPT codes that will not be reimbursed due to insufficient evidence.
Action Required
Before September 3, 2025: Billing team must update system to flag CPT codes 0133U, 0157U, 0159U, 0160U, 0161U, and 0162U as non-covered for Humana Medicaid members in South Carolina. Update encounter forms to alert providers that these genomic tests are not covered. Claims submitted for these codes will be denied.