Florida
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
850-412-4006
tom.wallace@ahca.myflorida.com
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:
- Chemistry
- Clinical cytogenetics
- Diagnostic immunology
- Genetic carrier screening
- Hematology
- Histocompatibility
- Immunohematology
- Microbiology
- 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:
- Chemistry;
- Clinical cytogenetics;
- Diagnostic immunology; and
- Genetic carrier screening.
Lynch Syndrome Testing Coverage
Florida Medicaid reimburses for the following services:
- Chemistry;
- Clinical cytogenetics;
- Diagnostic immunology; and
- Genetic carrier screening.
Microarray Testing
Newborn Screening
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.
Resources
- 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
On this Page
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.