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HumanaMedicaid · Prior Auth · Medicaid · KY · Hematology, Oncology, PathologyHigh impact

Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - KENTUCKY (New)

Effective date
Oct 14, 2026
Identified
Oct 7, 2026

Summary

Humana Kentucky Medicaid has implemented a new coverage policy (HUM-KY-2248-000) for genomic and molecular biomarker testing in cancer patients, effective 10/14/2026. The policy establishes coverage criteria and prior authorization requirements for specific multigene panel tests, single gene tests, liquid biopsies, and other molecular pathology tests used in hematologic malignancies, solid tumors, and thyroid nodule evaluation.

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What to do

Action · 6 steps
01Effective 10/14/2026: Billing team must implement prior authorization requirements for all genomic and molecular biomarker testing codes listed in this policy (81455, 81233, 81168, 81218, 81245, 81246, 81305, and related codes) when billing Humana Healthy Horizons Kentucky Medicaid members.
02Update billing system and prior authorization workflows to require documentation of specific clinical indications (e.g., AML, MDS, MPN, CLL/SLL, lymphomas, thyroid nodules) matching the policy's coverage criteria before submitting claims.
03Providers should review the detailed coverage determination section for each test type to understand eligible diagnoses.
04Train front-desk and billing staff to verify member eligibility under Kentucky Medicaid and collect required clinical information upfront.
05Note: For members under age 21, requests will be reviewed for medical necessity per EPSDT requirements.
06Claims submitted without meeting the stated indications or without prior authorization will be denied.

Codes mentioned

81455812338116881218812458124681305

Original notice

Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - KENTUCKY (New)
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 - VIRGINIA (Revised)MediumEffective Oct 14, 2026 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - MICHIGAN (New)HighEffective Sep 23, 2026 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - FLORIDA (Revised)HighEffective Oct 21, 2026 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - FLORIDA (Revised)MediumEffective Sep 16, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesKY policy changesHematologyOncologyPathologyCode 81455Code 81233Code 81168Code 81218Code 81245Code 81246Code 81305

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