← Back to list
Molecular Biomarker Testing for Noncancer Indications - MEDICAID - KENTUCKY (Revised)
Act
by Sep 23, 2026
Effective date
Sep 23, 2026
Identified
Sep 15, 2026
Summary
Humana Kentucky Medicaid revised its policy on molecular biomarker testing for noncancer indications, effective September 23, 2026. The policy explicitly denies coverage for gene expression profiling (GEP) tests and certain multianalyte assays (MAAAs) including longevity prediction, psychiatric condition testing, pain management profiling, endometrial implantation analysis, pulmonary disease testing, rheumatoid arthritis risk assessment, and scoliosis progression prediction. Prior authorization is required for covered molecular pathology testing (CPT 81479) and noninvasive prenatal screening codes.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
by Sep 23, 2026 · 5 steps
01Billing team must update billing system to DENY claims for the following codes under Kentucky Medicaid (Humana Healthy Horizons): CPT 81490, HCPCS 0289U, 0253U, 0294U, 0290U, 0291U, 0292U, 0293U, and CPT 81554, and 0004M.
02For CPT 81479 and NIPS codes (81509, 81510, 81511, 81512), implement mandatory prior authorization requirement in billing software.
03Create internal denial logic to automatically reject claims for GEP and MAAA tests for noncancer indications with explanatory denial messages citing lack of clinical evidence.
04Notify providers serving Kentucky Medicaid patients to stop ordering these tests effective the date.
05Update fee schedules and internal formularies to reflect non-covered status.
If missed: Failure to implement these changes will result in claim denials and potential audit issues.
Codes mentioned
81479814908150981510815118151281554
Original notice
Molecular Biomarker Testing for Noncancer Indications - MEDICAID - KENTUCKY (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Molecular Biomarker Testing for Noncancer Indications - MEDICAID - SOUTH CAROLINA (Revised)MediumEffective Aug 26, 2026 · MedicaidMolecular Biomarker Testing for Noncancer Indications - MEDICAID - FLORIDA (Revised)MediumEffective Sep 2, 2026 · MedicaidGene 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 · MedicaidBrowse every Humana change in the policy list