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
Elizabeth Pitman Director of the Division of Medical Services for the Medicaid Program
General Genetic Testing Criteria
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Hereditary/Metabolic Screening to be performed at age 1 month, if not performed either during the newborn evaluations or at the preferred age of 3-5 days.
Metabolic screening (e.g. thyroid, hemoglobinopathies, PKU, galactosemia) should be done according to state law.
Reimbursement for Child Health Services (EPSDT) screens, immunizations and lab procedures is based on the lesser of the billed amount or the Medicaid maximum.
Genetic Counseling Requirement
Metabolic Formula Coverage Legislation
Metabolic Formula Coverage & Criteria
Prior Authorization Requirements
The statement of medical necessity should indicate one of the following:
- Patient failed to understand the prenatal screening consent form;
- Patient’s risk on her prenatal screening result is higher than her chronologic age;
- Patient has an abnormal ultrasound and is offered an amniocentesis or chorionic villus sampling procedure;
- Patient is discovered to have a risk for a prenatally detectable genetic or chromosomal abnormality, metabolic disease, or neural tube defect not known at the time of the prenatal screen;
- Patient has significant anxiety regarding her risk of a genetic defect despite a negative prenatal screen; or
- Patient will be 35 years old at the time of delivery and remains concerned regarding her risk of a genetic defect.
Prior Authorization Forms
BRCA Testing Coverage
Requirements for BRCA
Cystic Fibrosis Screening
Hereditary Cancer Testing Coverage
Lynch Syndrome Testing Coverage
Prenatal Testing Offered
The Arkansas Medicaid Program covers prenatal screening for fetal anomalies using maternal serum HCG and AFP.
Whole Exome Sequencing
Other Tests Covered
- Provider Documents, Independent Laboratory, Section II, 292.560 Genetic Services https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/manuals/lab-prov/
- Provider Documents, Hyperalimentation, Section II, 242.120 https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/manuals/hyper-prov/
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.