MedicaidCoverageMedium impact
Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Oncology, Neurology, Pathology·Medicaid
Effective date
Sep 23, 2026
We identified it
Sep 16, 2026
Summary
Humana South Carolina Medicaid updated its genomic and molecular biomarker testing policy for cancer. The policy covers MGMT promoter methylation testing (CPT 81287) for glioma, but explicitly excludes coverage for LabCorp Plasma Complete (0585U) and TruD MDS Hepatocellular Carcinoma (0620U) due to insufficient evidence of clinical benefit. This is effective September 23, 2026.
Action Required
By September 23, 2026: Billing team must update billing software and claims processing rules to reflect coverage determination. (1) APPROVE claims for CPT 81287 (MGMT promoter methylation testing) when submitted for glioma cases with appropriate medical documentation. (2) DENY claims for CPT 0585U (LabCorp Plasma Complete) and CPT 0620U (TruD MDS Hepatocellular Carcinoma) with denial reason: 'Not covered—insufficient evidence of clinical benefit.' Include this language in all denial letters to members and providers. (3) Update EMR templates and order entry systems to flag these codes and alert providers to coverage limitations before ordering. (4) Train billing and prior authorization staff on the three affected codes and the glioma indication for 81287. For members under age 21, ensure all requests include EPSDT medical necessity review documentation.