Medicaid Proposal Would Standardize Lab Billing for Testing of Multiple Genes

The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy to standardize the billing and coding of next generation sequencing multigene panel laboratory tests across laboratory providers. The proposed changes would result in aligning Michigan Medicaid claim submission requirements with the Centers for Medicare & Medicaid Services requirements when multiple genes are tested. The proposed policy applies to Medicaid fee-for-service and indicates that Medicaid health plans and integrated care organizations would be required, at a minimum, to provide the full range of covered services described in the policy and may choose to provide additional services beyond those specified. Providers would be required to check with the beneficiary’s health plan for applicable coding, billing and authorization instructions.

Under the proposed policy, effective for dates of service on and after July 1, 2021, if a laboratory simultaneously assays multiple genes in parallel for an individual beneficiary, those genes would be considered part of the same panel, requiring submission of one procedure code. The laboratory would be directed not to report multiple individual procedures codes describing the gene component test results.

Providers are encouraged to review the proposal and submit comments to the MDHHS by May 19. Members with questions should contact Vickie Kunz at the MHA.