Rapid Whole Genome Sequencing (rWGS) of Critically Ill Infants - MEDICAID - LOUISIANA

This policy covers rapid whole genome sequencing (rWGS) and related genome sequencing CPT codes (e.g., 81425–81427, 81426) to provide timely molecular diagnosis to guide treatment and management of critically ill infants. Coverage is limited to inpatient infants with a suspected genetic etiology (for example, multiple congenital anomalies, refractory seizures, severe hypotonia, metabolic abnormalities such as hyperammonemia or abnormal newborn screen, or high‑risk BRUE features), requires prior authorization with documented pre‑ and post‑test genetic counseling and ordering by a qualified geneticist or subspecialist (neonatologist/pediatric intensivist), excludes cases with clear alternative explanations (e.g., isolated TTN, prematurity, HIE with known insult, responsive infection), and notes comparator genomes (81426) are billed separately while 81427 is for re‑evaluation of a prior genome.

"Abnormal glucose suggestive of inborn error of metabolism"