MedicaidCoverageMedium impact
Rapid Whole Genome Sequencing (rWGS) of Critically Ill Infants - MEDICAID - LOUISIANA (New)
Humana·LA · Genetics, Pediatrics, Critical Care·Medicaid
Effective date
Feb 16, 2024
We identified it
Jun 24, 2026
Summary
Humana Healthy Horizons Louisiana now covers rapid whole genome sequencing (rWGS) for critically ill infants under 12 months in ICU/pediatric units with complex genetic conditions. Coverage requires specific clinical criteria, genetic counseling, and ordering by specialists like geneticists or neonatologists.
Action Required
Immediately: Update billing system to recognize CPT codes 81425, 81426, and 81427 for rapid whole genome sequencing under Louisiana Medicaid. Ensure prior authorization process includes documentation of genetic counseling (both pre and post-testing) and specialist ordering requirements. Train billing team on coverage criteria for infants under 12 months in ICU with genetic conditions.