MedicaidCoverageMedium impact
Gene Expression Profiling for Cancer Indications - MEDICAID - INDIANA (Revised)
Humana·IN · Oncology, Dermatology, Pathology +1 more·Medicaid
Effective date
Sep 23, 2026
We identified it
Sep 15, 2026
Summary
Humana Medicaid Indiana updated its Gene Expression Profiling (GEP) policy for cancer indications, effective September 23, 2026. The policy covers molecular pathology testing (CPT 81479) for GEP when tests meet clinical validity standards, are suitable for intended purpose, and will change clinical management. This is a revised policy (version 002) with updated coding information and coverage determination criteria.
Action Required
By September 23, 2026: Billing team must ensure CPT 81479 (unlisted molecular pathology procedure) is properly configured in billing systems for Humana Medicaid Indiana members. Verify that claims for gene expression profiling tests include documentation demonstrating: (1) analytic validity, clinical validity, and clinical utility supported by peer-reviewed evidence; (2) assay suitability for intended purpose; and (3) evidence that results will change clinical management per specialty society recommendations. Update claim submission workflows and provider education materials to reflect these requirements. Claims submitted without adequate documentation of medical necessity will be subject to denial. Coordinate with providers and lab partners to ensure proper documentation is captured at time of service.