Coverage for Genetic Testing

Effective with processing date of July 1, 2013, and retroactive to dates of service on and after January 1, 2013, genetic testing is covered only when:

• There are signs and/or symptoms of an inherited disease in the affected individual.

• There has been a physical examination, pretest counseling, and other diagnostic studies.

• The determination of the diagnosis in the absence of such testing remains uncertain and would impact the care and management of the individual on whom the testing is performed.

Documentation to support medical necessity must be submitted with the claim. Providers will be responsible for resubmitting claims that may have been denied between January 1, 2013, and June 30, 2013, prior to coverage of the procedure codes.

Source: https://www.kmap-state-ks.us/Documents/Content/Bulletins/13077 - General - Gene Analysis.pdf