Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 219 - Laboratory Services
Chapter 1 - General
Rule 23-219-1.9 - Genetic Testing
Universal Citation: MS Code of Rules 23-219-1.9
Current through September 24, 2024
A. 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,
and
3. 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, or
5. 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.
Miss. Code Ann. §§ 43-13-117, 43-13-121.
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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