MedicaidCoverageHigh impact
PT 55-26: Expanded Coverage of Biomarkers Including Expanded Carrier Screening
Maryland Medicaid·MD · Oncology, Hematology, Cardiology +6 more·Managed Care
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Maryland Medicaid has expanded coverage for biomarker testing and carrier screening effective January 1, 2026. Multiple new CPT codes have been added to the fee schedule, with some requiring prior authorization (marked with 'P').
Action Required
Immediately: Billing team must update billing software to include new biomarker CPT codes with correct fee schedule rates. Configure prior authorization requirements for codes marked with 'P' (81223, 0340U, 0016M, 81539, 81541, 0047U, 0005U). Update encounter forms to include new codes for genetic testing, carrier screening, and biomarker analysis. Ensure contracted laboratory vendors are enrolled in Maryland Medicaid or establish contracts with proprietary test vendors.