Maryland Medicaid: Changes to biomarker test for companion diagnostic testing

Beginning Sept. 1, we’re implementing new coverage criteria for biomarker tests when they’re used as a companion diagnostic test for specific cancer treatments.

New coverage criteria

• The Food and Drug Administration (FDA) must approve the biomarker test
• The biomarker test must meet specific National Comprehensive Cancer Network (NCCN) cancer guidelines
  • Must be a NCCN level of Evidence category 2A and above
• The biomarker testing facility must meet Clinical Laboratory Improvement Amendments (CLIA) standards
• The companion drug/therapy must be FDA approved for that specific cancer treatment and be covered by the UnitedHealthcare Community Plan of Maryland

Keep in mind, if the new criteria aren’t met for the biomarker test, we’ll deny the claim.

Additional information

For more information on prior authorization requirements, testing limits and more, view the biomarkers for companion diagnostic testing and targeted drug therapy page.

Questions? 

• Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal Contact Us page
• Contact Provider Services at 877-842-3210.

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