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Update to “New Genetic Testing Benefits for Texas Medicaid Effective May 1, 2026”

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This is an update to the article titled “New Genetic Testing Benefits for Texas Medicaid Effective May 1, 2026,” which was published on this website on March 24, 2026.

ClonoSEQ Testing

The limitation for procedure code 0364U has been updated to six times per rolling year by any provider. Additional tests may be reimbursed for the same client on appeal with medical necessity.

For more information, call the TMHP Contact Center at 800-925-9126.

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.