Florida Medicaid's Rapid Whole Genome Sequencing (RWGS) Billing Guidance Webpage
- Ask Medicaid Florida
- Dec 11, 2025
- 2 min read
The purpose of this article is to provide an update to the previous alerts issued on October 14, 2025 and December 21, 2023 regarding RWGS.
Florida Medicaid's Rapid Whole Genome Sequencing (RWGS) Billing Guidance Webpage
Effective January 1, 2024, the Agency for Health Care Administration (Agency) began reimbursing for rapid whole genome sequencing provided to Medicaid recipients who:
Are 20 years of age or younger;
Have a complex or acute illness of unknown etiology that has not been caused by environmental exposure, toxic ingestion, an infection with normal response to treatment, or trauma, and;
Are receiving inpatient treatment in the high-acuity pediatric care unit of a hospital ICU.
Important Coverage Requirements for Providers
The Agency issued a Statewide Medicaid Managed Care (SMMC) Policy Transmittal (PT) on October 15, 2025 directing all SMMC health plans to waive prior authorization for children under 21 years. The PT can be found at this link: PT-2015-16.
Hospital providers will be reimbursed the additional maximum fee schedule amount in addition to inpatient reimbursement for diagnostic-related group (DRG) payment.
Key Details for Billing
Eligible Recipients: Medicaid recipients 20 or younger with an acute, complex, unknown-etiology illness in an ICU/high-acuity unit.
CPT Codes: 81425 (initial), 81426 (each additional), 81427 (reevaluation).
Billing for Hospitals: Use Revenue Code 310 (Pathology/General) in addition to CPT codes, reimbursed on top of DRG payment.
Billing for Labs: Use CPT codes 81425, 81426, 81427 on the independent lab fee schedule.
Date of Service: Must be on or after January 1, 2024.
Prior Authorization: Not required.
Documentation: Submit supporting documentation for medical necessity with the claim.
The Agency’s new web page on RWGS has been updated to include links for all of the individual SMMC plans that explains their billing guidance, a well as FFS guidance and links to applicable handbooks, fee schedules and Medicaid policies.
For additional information regarding these changes please visit: Rule 59G-4.150, F.A.C., Inpatient Hospital Services Coverage Policy, and Rule 59G-4.190, F.A.C., Laboratory Services Coverage Policy.
Disclaimer
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