MedicaidCoverageHigh impact
Molecular Biomarker Testing for Noncancer Indications - MEDICAID - KENTUCKY (Revised)
Humana·KY · OB-GYN, Psychiatry, Pain Management +6 more·Medicaid
Effective date
Sep 23, 2026
We identified it
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.
Action Required
By September 23, 2026: Billing 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. For CPT 81479 and NIPS codes (81509, 81510, 81511, 81512), implement mandatory prior authorization requirement in billing software. Create internal denial logic to automatically reject claims for GEP and MAAA tests for noncancer indications with explanatory denial messages citing lack of clinical evidence. Notify providers serving Kentucky Medicaid patients to stop ordering these tests effective the date. Update fee schedules and internal formularies to reflect non-covered status. Failure to implement these changes will result in claim denials and potential audit issues.