DC

Updated on March 31, 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

Yes

State Contact Information

Melisa Byrd Senior Deputy Director/State Medicaid Director melisa.byrd@dc.gov

General Genetic Testing Criteria

Genetic Testing Not Covered

See fee schedule for what tests are not listed as a covered benefit.

State Specific Definition

Genetic Services for Children

Genetic Counseling Requirement

Genetic Counseling is not listed as a covered benefit.

Metabolic Formula Coverage Legislation

Metabolic Formula Coverage & Criteria

Prior Authorization Requirements

Prior Authorization Forms

https://dhcf.dc.gov/sites/default/files/u23/New%20719A%202018%20Final.pdf

Fee Schedule

https://www.dc-medicaid.com/dcwebportal/nonsecure/feeScheduleDownload

BRCA Testing Coverage

Yes

Requirements for BRCA

An individual health plan or group health plan and health insurance coverage through Medicaid or the D.C. Healthcare Alliance program shall provide coverage for, and shall not impose any cost-sharing requirements on, women for the following preventive health services and products:
1. Risk assessment and genetic counseling and testing using the Breast Cancer Risk Assessment tool approved by the National Cancer Institute.

Cystic Fibrosis Screening

Certain CF tests are covered.

Hereditary Cancer Testing Coverage

Some hereditary cancers are covered.

Lynch Syndrome Testing Coverage

Microarray Testing

Microarray testing is not a covered benefit.

Newborn Screening

<p>Coverage is available.</p>

Panel Testing

Panel tests are not a covered tests.

Pharmacogenetic Testing

Prenatal Testing Offered

No coverage available.

Whole Exome Sequencing

WES is not listed as covered benefit.

Other Tests Covered

Other Information

Resources

https://code.dccouncil.us/dc/council/code/sections/31-3834.02.html https://dchealth.dc.gov/service/dc-newborn-metabolic-screening-program

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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