Rule 23-219-1.9 - Genetic TestingA. The Division of Medicaid defines genetic testing as a type of analysis that identifies changes in chromosomes, genes, or proteins that confirms or rules out a suspected genetic condition.B. The Division of Medicaid covers genetic testing when medically necessary to establish a diagnosis of an inheritable disease only when all of the following are met: 1. The beneficiary displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic),2. The result of the test will directly guide the treatment being delivered to the beneficiary, and3. After history, physical exam, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain.C. The Division of Medicaid does not cover genetic testing:1. Of family members of a beneficiary,2. If considered to be experimental, investigational or unproven,3. To determine the likelihood of passing on a trait,4. For the purpose of determining ancestry, or5. Other purposes not specifically defined that are not diagnostic in nature.D. Prior authorization is required by the Utilization Management/Quality Improvement Organization (UM/QIO) for medical necessity and appropriateness.23 Miss. Code. R. 219-1.9
Miss. Code Ann. §§ 43-13-117, 43-13-121.