MedicaidCoverageHigh impact
Expanded Coverage of Biomarkers Including Expanded Carrier Screening
Maryland Medicaid·MD · Genetics, Oncology, Cardiology +3 more·Managed Care Organizations
Effective date
Jan 1, 2026
We identified it
Sep 29, 2026
Summary
Maryland Medicaid expanded coverage of biomarker testing effective January 1, 2026, adding 27 new CPT and HCPCS codes to the fee schedule. Two codes (81443 Expanded Carrier Screening and 0340U Minimal Residual Disease Detection) require prior authorization. MCOs must contract with proprietary test vendors and may establish their own preauthorization policies.
Action Required
By January 1, 2026: Billing team must update billing system and fee schedules to include all 27 new biomarker CPT/HCPCS codes with corresponding FFS rates. Configure prior authorization requirements in billing software for CPT 81443 (Expanded Carrier Screening) and 0340U (Minimal Residual Disease Detection). Verify that all contracted laboratory vendors are enrolled in Maryland Medicaid; if vendors provide proprietary tests, ensure MCO contracts are in place with those specific vendors. Update billing guidelines and staff training materials to reflect the new covered biomarkers and prior auth requirements. Failure to implement these changes will result in claim denials for biomarker tests billed on or after January 1, 2026.