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HumanaMedicaid · Coverage · Medicaid · FL · Hematology, Oncology, PathologyMedium impact

Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - FLORIDA (Revised)

Effective date
Sep 16, 2026
Identified
Sep 15, 2026

Summary

Humana Florida Medicaid has released a revised policy (effective 09/16/2026) establishing coverage criteria for genomic and molecular biomarker testing in cancer patients. The policy specifies which hematologic malignancies, myeloid disorders, and solid tumors qualify for comprehensive genomic profiling (CGP) or single-gene testing, with strict limitations on eligible diagnoses. Billing teams must ensure claims for CPT codes 81450 and 81455 include documented medical necessity matching one of five defined indications.

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What to do

Action · 7 steps
01Before September 16, 2026: Billing team must update authorization and claims submission workflows to enforce coverage criteria for CPT 81450 and 81455 under Florida Medicaid.
02Require providers to document ONE of the five eligible indications—AML, MDS, MPN (PV/ET/PMF), suspected myeloid malignancy with undefined cytopenia >4 months, or systemic mastocytosis—on all genomic testing requests.
03Configure billing system to deny or hold claims that lack supporting diagnosis codes matching these criteria.
04Update prior authorization templates to mandate indication verification before approval.
05Train front-desk and billing staff to flag requests without compliant documentation.
06For members under 21, ensure EPSDT medical necessity review is performed.
07Claims submitted without documented eligible indications will be denied by Humana.

Codes mentioned

8145081455

Original notice

Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - FLORIDA (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - OHIO (New)MediumEffective Jan 7, 2026 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - FLORIDA (New)MediumEffective Jan 16, 2026 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - VIRGINIA (Revised)MediumEffective Oct 14, 2026 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - KENTUCKY (New)HighEffective Oct 14, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesFL policy changesHematologyOncologyPathologyCode 81450Code 81455

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