Benefit Criteria Has Changed for BRCA Testing

Effective for dates of service on or after November 1, 2010, the benefit criteria for breast cancer (BRCA) testing procedure codes S3820, S3822, and S3823 has changed for Texas Medicaid. The total component for procedure codes S3820, S3822, and S3823 is no longer a benefit for independent laboratory, FQHC, or free-standing and hospital-based RHC providers in the outpatient setting. Procedure codes S3820, S3822, and S3823 are limited to clients who are 18 years of age and older.