Effective July 1, 2025: Revised Payment Policy: Genetic and Molecular Testing Services

Date: 04/21/25

Superior HealthPlan, Ambetter from Superior HealthPlan and Wellcare By Allwell present a revised payment policy to communicate the expansion of requirements for billing molecular and genetic testing services. As a result, the following policy has been created, and is posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for review, prior to its implementation:

Policy	Effective Date	Applicable Products	New Policy Overview or Updated Policy Revisions
Genetic and Molecular Testing Services (TX.PP.551)	July 1, 2025	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Ambetter from Superior HealthPlan, Medicare (Wellcare By Allwell [HMO, HMO DSNP])	Expansion of the requirements for billing of molecular and genetic testing to advance the reliability of laboratory quality information and reduce variability in billing.

To review all clinical payment or payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Provider Services at:

• 1-877-391-5921 (Medicaid [STAR, STAR Health, STAR Kids, STAR+PLUS], CHIP)
• 1-800-977-7522 (Wellcare By Allwell [HMO])
• 1-877-935-8023 (Wellcare By Allwell [DSNP])
• 1-877-687-1196 (Ambetter from Superior HealthPlan)