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Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) (for New Mexico Only)
Effective date
Jan 1, 2027
Identified
Nov 7, 2026
Summary
UnitedHealthcare Community Plan of New Mexico revised its Medicaid medical policy for Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions), effective 2027-01-01. Pretest genetic counseling is now described as recommended rather than strongly recommended, the test-ordering criterion now allows orders placed in consultation with a listed specialist, the policy's outpatient or discharge-only scope is reworded, and CPT codes 0670U through 0677U were added to the applicable codes list.
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What to do
Action · 4 steps
01By 2027-01-01: Billing team should update charge entry and claim edits for New Mexico Community Plan Medicaid members so that CPT 0670U through 0677U are recognized when whole exome or whole genome sequencing is billed, and confirm the documentation packet supports the revised criteria (ordering provider or consulting specialist, clinical presentation, and any pretest genetic counseling note).
02Providers and ordering staff should be told that pretest genetic counseling is now worded as recommended and that orders may be placed in consultation with a medical geneticist, neonatologist, neurologist, immunologist, or developmental pediatrician.
03Confirm that oncology-related sequencing is routed to the separate Genetic Testing for Hereditary Cancer and Molecular Oncology policies.
04Watch for the payer's next notice before filing claims under the new criteria.
Original notice
Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) (for New Mexico Only)
uhcprovider.com · Always check the source before changing claims.
Related changes
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