{"data":{"id":"us-ok/okla.-stat.-tit.-56-56-4003","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 56, § 56-4003","heading":"Biomarker testing coverage","body":"A. As used in this section:\n\n1. \"Biomarker\", \"biomarker testing\", \"consensus statement\", and\n\n\"nationally recognized clinical practice guidelines\" shall have the\n\nsame meaning as provided by Section 1 of this act; and\n\n2. \"Contracted entity\" shall have the same meaning as provided\n\nby Section 4002.2 of Title 56 of the Oklahoma Statutes.\n\nB. The state Medicaid program shall cover biomarker testing in\n\naccordance with the requirements provided by this section.\n\nC. Biomarker testing shall be covered for the purposes of\n\ndiagnosis, treatment, appropriate management, or ongoing monitoring\n\nof a member’s disease or condition when the test is supported by\n\nmedical and scientific evidence, including, but not limited to:\n\n1. Labeled indications for a United States Food and Drug\n\nAdministration (FDA)-approved or -cleared test;\n\n2. Indicated tests for an FDA-approved drug;\n\n3. Warnings and precautions on FDA-approved drug labels;\n\n4. Centers for Medicare and Medicaid Services (CMS) national\n\ncoverage determinations or Medicare Administrative Contractor (MAC)\n\nlocal coverage determinations; or\n\n5. Nationally recognized clinical practice guidelines and\n\nconsensus statements.\n\nD. Contracted entities under the state Medicaid program shall\n\nprovide biomarker testing at the same scope, duration, and frequency\n\nas the Medicaid program otherwise provides to members.\n\nE. If prior authorization is required for biomarker testing,\n\nthe contracted entity shall approve or deny a prior authorization\n\nrequest and notify the member, the member’s provider, and any entity\n\nrequesting authorization of the service within seventy-two (72)\n\nhours for non-urgent requests or within twenty-four (24) hours for\n\nurgent requests.\n\nF. The member and the member’s provider shall have access to\n\nclear, readily accessible, and convenient processes to request an\n\nexception to a coverage policy for biomarker testing of the state\n\nMedicaid program. The process shall be made readily accessible to\n\nall participating providers and members online.","path":["OK Code","Title 56"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os56.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"c7d2e2b59e2998d57a9164cfdcaddf980ca4d00891251825f5e1ad538479e3a7","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-56-56-4002.8","next":"us-ok/okla.-stat.-tit.-56-56-4004"},"notice":"GroundRules: Original legal text. Not legal advice."}