Genetic Testing

Genetic Testing A. The Division of Medicaid defines genetic testing as a type of genetic analysis to confirm or rule out suspected genetic disorders. B. The Division of Medicaid covers genetic testing when medically necessary to establish a diagnosis when: 1. The beneficiary has significant clinical features suggestive of a genetic disorder, 2. The result of the test will directly impact clinical management and guide treatment being delivered to the beneficiary, and 3. After completion of conventional diagnostic studies, a definitive diagnosis remains uncertain. C. The Division of Medicaid defines genetic screening as a type of genetic analysis to identify risk of genetic disorders. D. The Division of Medicaid covers genetic screening as a pregnancy related service to support the health of the pregnant woman and fetus when: 1. The screening has not been performed previously during the same pregnancy 2. The beneficiary received all of the necessary information to make an informed decision and did not decline the screening. E. The Division of Medicaid does not cover genetic testing or screening: 1. If considered to be experimental, investigational or unproven, 2. For the purpose of determining ancestry, or 3. Other purposes not specifically defined that are not diagnostic in nature. F. Prior authorization is required for genetic testing and screening procedures as determined by the Division of Medicaid.