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Molecular Biomarker Testing for Noncancer Indications - MEDICAID - FLORIDA (Revised)
Act
by Sep 2, 2026
Effective date
Sep 2, 2026
Identified
Sep 2, 2026
Summary
Humana Florida Medicaid has revised its molecular biomarker testing policy for noncancer indications, effective September 2, 2026. The policy explicitly denies coverage for Gene Expression Profiling (GEP) for coronary artery disease (CPT 81493) and Multianalyte Assay with Algorithmic Analysis (MAAA) for rheumatoid arthritis risk prediction (CPT 81490), citing insufficient evidence. However, molecular pathology testing (CPT 81479) and unlisted MAAA (CPT 81599) remain eligible for coverage when they meet specific clinical validity criteria.
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What to do
by Sep 2, 2026 · 5 steps
01Billing team must implement denial logic in the billing system for CPT 81490 (rheumatoid arthritis risk assessment) and CPT 81493 (coronary artery disease gene expression profiling) for all Florida Medicaid claims.
02Update claim rejection rules to automatically deny these codes with reason code indicating lack of medical necessity per policy HUM-FL-2253-001.
03For CPT 81479 and CPT 81599 submissions, ensure prior authorization requests include documentation of analytic validity, clinical validity, clinical utility, and expected change in clinical management per specialty society guidelines.
04Notify cardiology, rheumatology, and internal medicine providers that GEP for CAD prediction and biomarker testing for RA risk stratification are no longer covered; alternative testing approaches should be discussed with members before ordering.
05Update denial templates and provider communications accordingly.
If missed: Failure to implement these denials may result in improper payments that trigger recovery audits.
Codes mentioned
81479814908149381599
Original notice
Molecular Biomarker Testing for Noncancer Indications - MEDICAID - FLORIDA (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Gene Expression Profiling for Cancer Indications - MEDICAID - FLORIDA (Revised)MediumEffective Oct 21, 2026 · MedicaidGene Expression Profiling for Cancer Indications - MEDICAID - VIRGINIA (Revised)HighEffective Oct 14, 2026 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - MICHIGAN (New)HighEffective Sep 23, 2026 · MedicaidGene Expression Profiling for Cancer Indications - MEDICAID - SOUTH CAROLINA (Revised)MediumEffective Sep 23, 2026 · MedicaidBrowse every Humana change in the policy list