Effective January 1, 2022, rWGS is a covered benefit for clinically eligible Medi-Cal beneficiaries.
Now, the most advanced diagnostic test of rare genetic disease is available for babies in intensive care.
Patients insured by Medi-Cal in both fee-for-service (FFS) and Medi-Cal managed care plans.
Patients 1 year of age or younger admitted to an intensive care unit in the hospital (NICU, PICU, CVICU).
No additional authorization is required for Medi-Cal patients meeting clinical criteria to order rWGS testing. rWGS is ordered similarly to other diagnostic tests during the inpatient stay.
Coverage language was codified into law based on the demonstrated clinical utility of rWGS to diagnose and inform treatment decisions for critically ill patients in intensive care through projects such as Project Baby Bear (see the final report and AJHG publication), Project Baby Deer (initial results, Michigan coverage toolkit, Michigan rWGS policy), and in a large body of research (see our publications).
CPT® codes 0094U*, 0212U, 0213U and 81425 thru 81427 are a covered benefit for any Medi-Cal beneficiary who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit. (Medi-Cal Provider Bulletin December 2021, section 6)
*Please note, when ordering rWGS/urWGS through RCIGM, PLA CPT 0094U should be used for the proband sequencing, and an instance of 81426 for each comparator sample sequenced. 0094U is RCIGM’s proprietary laboratory analysis CPT code representing rapid whole genome sequencing (81425-7 represents any general whole genome sequencing).
California Health Trailer Bill AB 133, Section 26, effective January 1, 2022, makes rWGS a covered benefit for clinically eligible Medi-Cal beneficiaries. You may know it as the Rare Disease Sequencing for Critically Ill Infants Act (AB 114) that was introduced in December 2020 by Brian Maienschein (D) of California’s 77 Assembly District. Its use in your clinical practice could yield vital information needed for medical decision-making and ultimately save lives and resources.
Rady Children’s Institute for Genomic Medicine is a non-profit research organization embedded within Rady Children’s Hospital-San Diego.
RCIGM offers the highest quality rapid and ultra-rapid clinical whole genome sequencing. Learn more about the clinical services we offer.
Along with optimizing our genome sequencing platform and Rapid Precision Medicine delivery system, we are scaling and sharing our tools and expertise in rare disease with a growing network of children’s hospitals globally to make cutting edge healthcare widely available