MedicaidCoverageMedium impact
Pharmacogenomics Testing - MEDICAID - FLORIDA (Revised)
Humana·FL · Oncology, OB-GYN, Genetics +1 more·Medicaid
Effective date
Sep 16, 2026
We identified it
Sep 24, 2026
Summary
Humana Medicaid Florida updated its pharmacogenomics testing policy (effective 09/16/2026) to clarify coverage for ChemoFx Assay (CPT 81535/81536) in gynecologic cancers and molecular pathology testing (CPT 81479) for drug-gene interactions meeting FDA or CPIC guideline criteria. The policy includes special EPSDT protections for members under age 21. This is the third version of a policy originally effective 04/01/2025, with the most recent annual review and coding updates completed 04/07/2026.
Action Required
By 09/16/2026: Billing team must ensure claims submission systems recognize CPT codes 81479, 81535, and 81536 for Humana Medicaid Florida members. Verify that prior authorization is submitted for all pharmacogenomics testing requests and that clinical documentation includes: (1) for ChemoFx Assay—confirmation of gynecologic cancer diagnosis with one of the five qualifying indications (rare cancer, initial biopsy/surgery, recurrent, treatment-refractory, or intolerance); (2) for molecular pathology testing—evidence of FDA labeling or CPIC guideline level A or B gene-drug interaction. For members under age 21, flag requests for EPSDT medical necessity review. Update provider order entry templates and billing worksheets to reflect these requirements. Claims lacking proper documentation or authorization will be denied.