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

Tom Wallace, Deputy Secretary for Medicaid

General Genetic Testing Criteria

Florida Medicaid reimburses for the following services in accordance with the American Medical Association’s Current Procedural Terminology (CPT) and the applicable Florida Medicaid fee schedule(s), or as specified in this policy:

  1. Chemistry
  2. Clinical cytogenetics
  3. Diagnostic immunology
  4. Genetic carrier screening
  5. Hematology
  6. Histocompatibility
  7. Immunohematology
  8. Microbiology
  9. Pathology

Genetic Testing Not Covered

State Specific Definition

Genetic Services for Children

Genetic Counseling Requirement

Metabolic Formula Coverage Legislation

Chapter 191

Metabolic Formula Coverage & Criteria

Chapter 191

Prior Authorization Requirements

The Agency for Health Care Administration has contracted with a certified Quality Improvement Organization (QIO), eQHealth Solutions, Inc. to provide medical necessity reviews for Medicaid home health services.

Prior Authorization Forms


Fee Schedule


BRCA Testing Coverage

Requirements for BRCA

Cystic Fibrosis Screening

Hereditary Cancer Testing Coverage

Florida Medicaid reimburses for the following services:

  1. Chemistry;
  2. Clinical cytogenetics;
  3. Diagnostic immunology; and
  4. Genetic carrier screening.

Lynch Syndrome Testing Coverage

Florida Medicaid reimburses for the following services:

  1. Chemistry;
  2. Clinical cytogenetics;
  3. Diagnostic immunology; and
  4. Genetic carrier screening.

Microarray Testing

Newborn Screening

<p>Florida Medicaid reimburses the state laboratory for mandated tests.</p>

Panel Testing

Pharmacogenetic Testing

Prenatal Testing Offered

Whole Exome Sequencing

Other Tests Covered

Other Information

The Children’s Medical Services (CMS) Regional Genetics Program provides access to specialized medical care for these inherited conditions. Medical evaluations, diagnosis and counseling services are available for children under the age of 21.


  • Laboratory Services Rule Number 59G-4.190
    • https://ahca.myflorida.com/medicaid/review/specific_policy.shtml
  • Florida’s Covered Services
    • https://ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/Covered_Services_HCBS_Waivers.shtml
  • Children’s Medical Services Regional Genetics Program:
    • http://www.cms-kids.com/
    • http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/
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.

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