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UnitedHealthcareMedicaid · Billing Codes · Medical Policy · KY · Genetics, Pediatrics, Neurology +1 moreMedium impact

Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) (for Kentucky Only)

Effective date
Jan 1, 2027
Identified
Nov 7, 2026

Summary

UnitedHealthcare Community Plan of Kentucky revised its Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) medical policy for Kentucky Medicaid members, with the revised policy effective 2027-01-01. Key changes include revised medical necessity criteria (the test must now be ordered by or in consultation with a medical geneticist, neonatologist, neurologist, immunologist, or developmental pediatrician), pretest genetic counseling now recommended rather than strongly recommended, state-specific reference to Kentucky Revised Statutes § 304.17A-263 for biomarker testing criteria, and eleven new CPT codes (0657U, 0658U, 0659U, 0670U–0677U) added to the applicable codes list.

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What to do

Action · 4 steps
01By 2027-01-01: Billing team, update charge entry and claim edits for Kentucky Medicaid members so that CPT codes 0657U, 0658U, 0659U, 0670U through 0677U are recognized for whole exome and whole genome sequencing orders.
02Providers and front desk staff should be told that orders must come from or be made in consultation with a medical geneticist, neonatologist, neurologist, immunologist, or developmental pediatrician, and that pretest genetic counseling is recommended.
03Before scheduling sequencing for these members, check the revised medical necessity criteria and the Kentucky statute referenced for biomarker testing, and gather supporting documentation of the qualifying clinical presentation.
04Oncology-related sequencing is addressed in separate policies and should be routed accordingly.

Original notice

Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) (for Kentucky Only)
uhcprovider.com · Always check the source before changing claims.
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