Mississippi
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
Drew Snyder
Executive Director of the Mississippi Division of Medicaid
550 High Street, Suite 1000, Jackson, MS 39201
(800)-421-2408
General Genetic Testing Criteria
The Division of Medicaid covers genetic testing when medically necessary to establish a diagnosis of an inheritable disease only when all of the following are met:
- The beneficiary displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic);
- The result of the test will directly guide the treatment being delivered to the beneficiary; and
- After history, physical exam, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain.
Genetic Testing Not Covered
The Division of Medicaid does not cover genetic testing:
- Of family members of a beneficiary;
- If considered to be experimental, investigational or unproven;
- To determine the likelihood of passing on a trait;
- For the purpose of determining ancestry; or
- Other purposes not specifically defined that are not diagnostic in nature.
State Specific Definition
The Division of Medicaid defines genetic testing as a type of analysis that identifies changes in chromosomes, genes, or proteins that confirms or rules out a suspected genetic condition.
Genetic Services for Children
Genetic Counseling Requirement
Metabolic Formula Coverage Legislation
Metabolic Formula Coverage & Criteria
Prior Authorization Requirements
Prior authorization is required by the Utilization Management/Quality Improvement Organization (UM/QIO) for medical necessity and appropriateness.
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Coverage is available.
Requirements for BRCA
Cystic Fibrosis Screening
Hereditary Cancer Testing Coverage
The Division of Medicaid covers genetic testing when medically necessary to establish a diagnosis of an inheritable disease only when all of the following are met:
- The beneficiary displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic);
- The result of the test will directly guide the treatment being delivered to the beneficiary; and
- After history, physical exam, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain.
Lynch Syndrome Testing Coverage
The Division of Medicaid covers genetic testing when medically necessary to establish a diagnosis of an inheritable disease only when all of the following are met:
- The beneficiary displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic);
- The result of the test will directly guide the treatment being delivered to the beneficiary; and
- After history, physical exam, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain.
Microarray Testing
Newborn Screening
Panel Testing
Pharmacogenetic Testing
Prenatal Testing Offered
Whole Exome Sequencing
Other Tests Covered
Other Information
Resources
- Title 23 of the Mississippi Administrative Code, Part 219: Laboratory Services
- https://medicaid.ms.gov/wp-content/uploads/2014/10/Admin-Code-Part-219.pdf
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.
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