Updated on February 10, 2023

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

Renee Gayhart
Director of Division of Health Care Services 240 Main St., Ste 202
Juneau AK 99801
Phone: 907-465-1184

General Genetic Testing Criteria

Alaska Medicaid covers medically necessary genetic testing when all of the following conditions are met:

  1. The recipient displays clinical features of a suspected genetic condition or is at direct risk of inheriting the genetic condition in question (e.g., a causative familial variant has been identified);
  2. Clinical studies published in peer-reviewed literature have established strong evidence that the result of the test will positively impact the clinical decision-making or clinical outcome for the member;
  3. The testing method is proven to be scientifically valid for the identification of a specific genetically-linked inheritable disease or clinically important molecular marker; and
  4. Documentation is provided from a physician with genetic expertise that supports the recommendation for testing based on a review of risk factors, clinical scenario, and family history.

Genetic Testing Not Covered

Alaska Medicaid does not cover:

  1. Services that do not appear on the Independent Laboratory Services Fee Schedule;
  2. Pharmacogenetics testing panels (e.g., GeneSight Psychotropic, Genecept Assay, SureGene Test, and Mental Health DNA Insight Panel) for any indication including psychotropic or pain medication prescribing;
  3. CPT 80300-80377;
  4. CPT 81228 and 81229 if the recipient has had CMA performed previously;
  5. CPT 81226 if the recipient is taking tetrabenazine;
  6. CPT 81227 (CYP2C9);
  7. CPT 81240 F2 or 81241 FV for
    1. Routine screening for pregnant women;
    2. Adults with idiopathic venous thromboembolism (VTE); or
    3. Adult family members of individuals with identified genetic mutations.

State Specific Definition

Genetic Services for Children

Genetic Counseling Requirement

Alaska Medicaid considers genetic counseling to be part of the evaluation and management service with no additional reimbursement for genetic counseling by itself.

Metabolic Formula Coverage Legislation

Metabolic Formula Coverage & Criteria

Prior Authorization Requirements

Claims for all genetic testing must be accompanied by a Genetic Testing Supporting Information form and a lab report. Failure to attach these documents will result in claim denial.

Prior Authorization Forms

Fee Schedule

BRCA Testing Coverage


Requirements for BRCA

Cystic Fibrosis Screening

Hereditary Cancer Testing Coverage

Lynch Syndrome Testing Coverage


Microarray Testing

Alaska Medicaid covers cytogenomic constitutional (genome-wide) microarray analysis (CMA) once in a recipient’s lifetime if the recipient has not had CMA performed previously. CPT 81228, interrogation of genomic regions for copy number variants (e.g., bacterial artificial chromosome [BAC] or oligo-based comparative genomic hybridization [CGH] microarray analysis) is covered if the recipient meets one or more of the following criteria:

  1. Has at least one major congenital anomaly or multiple congenital anomalies, other than those associated with an obvious, specific, and well-defined genetic syndrome;
  2. Has a developmental delay (DD) or intellectual disability (ID) and all of the following are met: there is no known etiology for the DD/ID (e.g., trauma, infection); the DD/ID is not suspected to be related to an obvious, specific, and well-defined genetic syndrome; the patient shows evidence of at least one major congenital anomaly.
  3. Has an autism spectrum disorder and has at least one major congenital anomaly Interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities (CPT 81229) is covered if the recipient meets the above criteria as well as on or more of the following: Consanguinity and recessive disease are suspected; Uniparental Disomy (UPD) is suspected; or Another mechanism is suspected that would not be detected by the oligo microarray.

Newborn Screening

<p>Alaska Medicaid covers newborn bloodspot screening performed in a hospital through the hospital’s prospective per diem rate. No additional reimbursement is allowed to the healthcare provider collecting the sample or for additional samples collected outside of the inpatient hospital setting. If the sample is not collected by the hospital, another healthcare provider may collect the sample outside of the hospital setting and be reimbursed for the newborn bloodspot screening. For babies delivered outside of a hospital setting, providers are reimbursed for newborn bloodspot screenings at the fee for service rate listed on the applicable fee schedule.</p> <p>No additional reimbursement is allowed for the collection of the sample. For additional information on the newborn bloodspot screening requirements, visit DPH’s Newborn Bloodspot Screening Program webpage.</p>

Panel Testing

Pharmacogenetic Testing

Alaska Medicaid covers the test for CYP2C19 (CPT 81225) only for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) who are initiating or reinitiating Clopidogrel (Plavix). The test for CYP2D6 (CPT 81226) is covered only if one or more of the following criteria are met:

  1. Recipient is on doses of Pimozide of more than 4mg/day (adult) or 0.05mg/day (child)
  2. Recipient has Gaucher disease type 1 and is a candidate for and is considering treatment with eliglustat, and has received medication service authorization approval under the pharmacy benefit
  3. Recipient has failed at least two other antidepressants being initiated on antidepressant therapy with amitriptyline or nortriptyline.

Note: CYP2D6 will not be authorized for a patient prescribed amitriptyline or nortriptyline for neuropathic pain indications.

Prenatal Testing Offered

Whole Exome Sequencing

Other Tests Covered

Alaska Medicaid covers spinal muscular atrophy (SMA) carrier screening (CPT 81329) for once per lifetime for recipients with a positive pregnancy test and one of the following conditions:

  1. Previous carrier status in at least one parent; and
  2. Family history of SMA in first or second degree relative of high risk partner (maternal or paternal).

Alaska Medicaid covers breast cancer gene expression profiling once in a recipient’s lifetime if the recipient has not been tested previously, regardless of payer.

Other Information

  • Coagulation Factors II and V
    • “Alaska Medicaid covers coagulation factor II (CPT 81240 F2) and V (CPT 81241 FV) gene analysis for recipients under 21 years of age experiencing spontaneous thrombosis, non-catheter related venous thrombosis, or stroke. “
  • Genetics Pediatric Clinic – “The Providence Genetics Clinic will be staffed by a coordinator, genetic counselors and contracted out-of-state Geneticists. Clinics will be held every other month and the genetics team will continue to travel to Fairbanks and Juneau for outreach clinics.”


  • AK Provider Billing Manual, Independent Laboratory, Genetic Testing
  • AK Provicer Billing Manual, Durable Medical Equipment, Medicaid Covered Services
  • AK Provider Billing Manual, Physician, Medicaid Covered Services Alaska Coagulation Factors II and V
Newborn Screening Reimbursement


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.

The database contains links to third-party websites. These links are provided solely as a convenience to users and not as a guarantee, warrantee, or recommendation by NCC of the content on such third-party websites or as an indication of any affiliation, sponsorship or endorsement of such third party websites. NCC is not responsible for the content of linked third-party sites and does not make any representations regarding the privacy practices of, or the content or accuracy of materials on, such third-party websites. If you decide to access linked third-party websites, you do so at your own risk. Your use of third-party websites is subject to the terms of use for such sites.