Alabama
This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.
Medicaid Coverage Information Published
State Contact Information
Stephanie McGee Azar Commissioner of Alabama Medicaid Agency (334)-242-5600
General Genetic Testing Criteria
The recipient must meet at least one of the criteria listed below:
- Maternal age 35 years or older at delivery; OR
- Fetal ultrasonographic findings indicating an increased risk of aneuploidy; OR
- History of a prior pregnancy with a trisomy; OR
- Parental balanced Robertsonian translocation with increased risk of fetal trisomy 13 or trisomy 21; OR
- Positive test result for aneuploidy, including first trimester, sequential, or integrated screen, or a quadruple screen.
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
Metabolic Formula Coverage Legislation
Metabolic Formula Coverage & Criteria
Prior Authorization Requirements
NIPT requires prior authorization forms.
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
No coverage available.
Requirements for BRCA
No coverage available.
Cystic Fibrosis Screening
No coverage available.
Hereditary Cancer Testing Coverage
No coverage available
Lynch Syndrome Testing Coverage
No coverage available.
Microarray Testing
Newborn Screening
Panel Testing
Organic acidemia disorders, including:
- 3-hydroxy-3-methylglutaryl-CoA lyase deficiency (HMG)
- 3-Methylcrotonyl-CoA carboxylase deficiency (3MCC)
- β-ketothiolase deficiency (BKT)
- Glutaric acidemia type I (GA1)
- Isovaleric acidemia (IVA)
- Methylmalonic acidemia (MUT and CblA,B)
- Multiple carboxylase deficiency (MCD)
- Propionic acidemia (PROP)
Pharmacogenetic Testing
Prenatal Testing Offered
Alabama Medicaid Agency will cover the following NIPT testing procedure codes with prior authorization:
- Fetal chromosomal aneuploidy (e.g., trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21;
- Fetal aneuploidy (trisomy 21,18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy.
Medicaid may cover these tests for women with singleton gestations considered at increased risk for fetal aneuploidy in whom cell free fetal DNA may be used as a primary screening option. The recipient must meet at least one of the criteria listed below:
- Maternal age 35 years or older at delivery; OR
- Fetal ultrasonographic findings indicating an increased risk of aneuploidy; OR
- History of a prior pregnancy with a trisomy; OR
- Parental balanced Robertsonian translocation with increased risk of fetal trisomy 13 or trisomy 21; OR
- Positive test result for aneuploidy, including first trimester, sequential, or integrated screen, or a quadruple screen.
Whole Exome Sequencing
Other Tests Covered
Medicaid will cover the Oncotype DXTM genetic profiling lab test if the patient meets Medicaid’s prior authorization criteria.
Other Information
Child Growth Hormone needed for Genetic Conditions avaliable for Alabama Medicaid Pharmacy
Child Growth Hormone /
Turner Syndrome, Prader-Willi Syndrome, Noonan Syndrome PA Request Form (https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.14_PA_Forms/9.4.14_PH_PA_Form_410-B_CGH_Syndromes_12-1-21.pdf)
Resources
- Provider Manual Section 20 (Laboratory) https://www.medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals.aspx
- Covered Nutritional List and Nutritional Diagnosis Grid https://www.medicaid.alabama.gov/content/9.0_Resources/9.4_Forms_Library/9.4.13_Pharmacy_Forms.aspx
- APEC (Alabama Perinatal Excellence Collaborative) Cell Free DNA Guidelines http://apecguidelines.org/guideline/fetal-screening-high-risk/ APEC guidelines for prenatal screening for chromosome abnormalities, genetic disease, and birth defects http://apecguidelines.org/guideline/premature-rupture-of-membrane/
- NIPT testing https://medicaid.alabama.gov/alert_detail.aspx?ID=14131
Newborn Screening Reimbursement
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Disclaimer: The information contained in the database has been obtained from sources believed to be reliable but NCC has not attempted to validate or confirm the information. The database may be updated periodically. However, the accuracy and completeness of the information contained in the database cannot be, and is not, guaranteed. NCC makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user’s responsibility to verify this information by contacting the state Medicaid agency directly.
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