Medicaid Coverage of BRCA Gene Analysis

BRCA gene analysis is a standard of practice for preventative testing and treatment for women with a high risk of BRCA mutation. The South Dakota Legislature approved funding for BRCA gene analysis. Effective July 1, 2016, BRCA testing is covered by SD Medicaid. Services require prior authorization. The prior authorization criteria and form are available on their website: https://dss.sd.gov/medicaid/providers/pa/  The CPT codes and associated fees are also available on the department’s website: https://dss.sd.gov/medicaid/providers/feeschedules/dss/.