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Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - FLORIDA (Revised)
Effective date
Oct 21, 2026
Identified
Oct 15, 2026
Summary
Humana Florida Medicaid revised its Genomic and Molecular Biomarker Testing for Cancer policy (HUM-FL-2248-002), effective 10/21/2026. The policy establishes coverage criteria for single-gene testing (BTK, CEBPA, IDH1/IDH2, MYD88, NPM1, PLCG2), panel testing, liquid biopsy, thyroid molecular markers, and molecular pathology procedures for hematologic and solid organ malignancies. This revision supersedes the original policy effective 08/05/2025.
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What to do
Action · 7 steps
01By 10/21/2026, the billing team must.
02Update the billing system and prior authorization protocols to reflect the new coverage criteria for genomic and molecular biomarker testing CPT codes 81120, 81121, 81218, 81233, 81305, 81310, and 81320 for Florida Medicaid members.
03Ensure prior authorization is obtained for applicable tests based on the source-stated medical indications (e.g., disease progression for BTK inhibitor therapy, AML/MDS/MPN diagnosis for CEBPA testing).
04Verify that claims for these codes include documentation supporting one of the covered indications listed in the policy.
05For members under age 21, confirm requests are reviewed for medical necessity per EPSDT requirements.
06Reference the full policy text at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5f53b4 for complete coverage determination rules, as the document provided is incomplete ('Humana m-' text cuts off mid-sentence).
07Claims submitted without proper authorization or missing required clinical documentation may be denied.
Codes mentioned
81120811218121881233813058131081320
Original notice
Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - FLORIDA (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Genomic and Molecular Biomarker Testing for Cancer - MEDICAID - MICHIGAN (New)HighEffective Sep 23, 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 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - INDIANA (Revised)HighEffective Sep 23, 2026 · MedicaidBrowse every Humana change in the policy list