Minnesota

Yes

Cynthia MacDonald
Assistant Commissioner of the Health Care Administration at the Minnesota Department of Human Services and the State Medicaid Director
(651)-431-2670

MHCP covers genetic testing when medically necessary. Genetic testing is considered medically necessary when all of the following conditions are met and documented in the medical record:

1. The recipient displays clinical features or is at direct risk of inheriting the genetic condition in question (pre-symptomatic)
2. The result of the test will have a clinically significant impact on the treatment being delivered for a disease or syndrome
3. The testing method is considered scientifically valid for the identification of a specific genetically linked inheritable disease
4. Appropriate genetic counseling occurs before and after testing. Counseling documentation supports the intent to change therapy based on the results of the testing

Exome and genome testing requirements will be reviewed on a case-by-case basis. Claims must include an attachment that explains the medical necessity for the test and indicates how the results of the test will influence treatment. Claims will pend until each case is reviewed for the medical necessity of the test and what the results of the test will have on treatment.

Genetic testing is not covered when performed in the absence of symptoms or high risk factors for an inheritable disease or when knowledge of genetic status will not affect treatment decisions. Tests for conditions that are treated symptomatically are not appropriate since the treatment would not change due to the test results.
MHCP does not cover cytogenetic testing for:

1. Legal, paternity or informational purposes;
2. Family members who are not MHCP recipients; or
3. Fetus testing.

256B.0625 COVERED SERVICES. Subd. 32.Nutritional products. Medical assistance covers nutritional products needed for nutritional supplementation because solid food or nutrients thereof cannot be properly absorbed by the body or needed for treatment of phenylketonuria, hyperlysinemia, maple syrup urine disease, a combined allergy to human milk, cow’s milk, and soy formula, or any other childhood or adult diseases, conditions, or disorders identified by the commissioner as requiring a similarly necessary nutritional product. Nutritional products needed for the treatment of a combined allergy to human milk, cow’s milk, and soy formula require prior authorization. Separate payment shall not be made for nutritional products for residents of long-term care facilities. Payment for dietary requirements is a component of the per diem rate paid to these facilities.

256B.0625 COVERED SERVICES. Subd. 32.Nutritional products. Medical assistance covers nutritional products needed for nutritional supplementation because solid food or nutrients thereof cannot be properly absorbed by the body or needed for treatment of phenylketonuria, hyperlysinemia, maple syrup urine disease, a combined allergy to human milk, cow’s milk, and soy formula, or any other childhood or adult diseases, conditions, or disorders identified by the commissioner as requiring a similarly necessary nutritional product. Nutritional products needed for the treatment of a combined allergy to human milk, cow’s milk, and soy formula require prior authorization. Separate payment shall not be made for nutritional products for residents of long-term care facilities. Payment for dietary requirements is a component of the per diem rate paid to these facilities.

https://edocs.dhs.state.mn.us/lfserver/Public/DHS-4695-ENG

https://mn.gov/dhs/partners-and-providers/policies-procedures/minnesota-health-care-programs/provider/billing/fee-schedule/

Coverage is available.

Genetic testing is considered medically indicated and is covered for recipients with all of the following breast cancer characteristics:

1. Stage I or II breast cancer;
2. Breast tumor is estrogen-receptor positive;
3. Breast tumor is HER2-receptor negative;
4. Tumor size 0.6-1 cm with moderate or poor differentiation or unfavorable features, or tumor size >1 cm;
5. Negative lymph nodes (nodes with micrometastases > 2 mm in size); or
6. Test result will be used to guide decision making about adjuvant chemotherapy.

MHCP covers genetic testing when medically necessary. Genetic testing is considered medically necessary when all of the following conditions are met and documented in the medical record:

1. The recipient displays clinical features or is at direct risk of inheriting the genetic condition in question (pre-symptomatic)
2. The result of the test will have a clinically significant impact on the treatment being delivered for a disease or syndrome
3. The testing method is considered scientifically valid for the identification of a specific genetically linked inheritable disease
4. Appropriate genetic counseling occurs before and after testing. Counseling documentation supports the intent to change therapy based on the results of the testing

Exome and genome testing requirements will be reviewed on a case-by-case basis. Claims must include an attachment that explains the medical necessity for the test and indicates how the results of the test will influence treatment. Claims will pend until each case is reviewed for the medical necessity of the test and what the results of the test will have on treatment.

Genetic testing is not covered when performed in the absence of symptoms or high-risk factors for an inheritable disease or when knowledge of genetic status will not affect treatment decisions. Tests for conditions that are treated symptomatically are not appropriate since the treatment would not change due to the test results.

Pharmacogenetic testing is covered when all the following conditions are met:

1. Testing is required by the drug label;
2. The test will change the treatment course;
3. A drug trial is considered impractical due to safety or other factors prior to genetic testing.

Pharmacogenetic panel tests for therapy selection, such as panel tests for psychotropics, analgesics or ADHD stimulant medications, are not covered.

MHCP does not cover cytogenetic testing for:

1. Legal, paternity or informational purposes;
2. Family members who are not MHCP members;
3. Fetus testing.

MHCP covers genetic testing when medically necessary. Genetic testing is considered medically necessary when all of the following conditions are met and documented in the medical record:

1. The recipient displays clinical features or is at direct risk of inheriting the genetic condition in question (pre-symptomatic)
2. The result of the test will have a clinically significant impact on the treatment being delivered for a disease or syndrome
3. The testing method is considered scientifically valid for the identification of a specific genetically linked inheritable disease
4. Appropriate genetic counseling occurs before and after testing. Counseling documentation supports the intent to change therapy based on the results of the testing

Exome and genome testing requirements will be reviewed on a case-by-case basis. Claims must include an attachment that explains the medical necessity for the test and indicates how the results of the test will influence treatment. Claims will pend until each case is reviewed for the medical necessity of the test and what the results of the test will have on treatment.

Genetic testing is not covered when performed in the absence of symptoms or high-risk factors for an inheritable disease or when knowledge of genetic status will not affect treatment decisions. Tests for conditions that are treated symptomatically are not appropriate since the treatment would not change due to the test results.

Pharmacogenetic testing is covered when all the following conditions are met:

1. Testing is required by the drug label;
2. The test will change the treatment course;
3. A drug trial is considered impractical due to safety or other factors prior to genetic testing.

Pharmacogenetic panel tests for therapy selection, such as panel tests for psychotropics, analgesics or ADHD stimulant medications, are not covered.

MHCP does not cover cytogenetic testing for:

1. Legal, paternity or informational purposes;
2. Family members who are not MHCP members;
3. Fetus testing.

Pharmacogenetic testing is covered when all the following conditions are met:

1. Testing is required by the drug label
2. The test will change the treatment course
3. A drug trial is considered impractical due to safety or other factors prior to genetic testing

Pharmacogenetic panel tests for therapy selection, such as panel tests for psychotropics, analgesics or ADHD stimulant medications, are not covered.

• Provider Manual: Laboratory and Pathology Services
  • https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_144353#cs MHCP
• Provider Manual, Equipment and Supplies, Nutritional Products
  • https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_145320
• 2019 MN Statutes, Genetic Counselors
  • https://www.revisor.mn.gov/statutes/cite/147F
• BRCA Coverage
  • https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS-290809 Metabolic
• Food Legislation:
  • https://www.revisor.mn.gov/statutes/cite/256B.0625
• Newborn Screening:
  • https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_150092