Nebraska
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
Kevin Bagley
Director, Division of Medicaid & Long-Term Care
Nebraska Department of Health and Human Services
301 Centennial Mall South, 3rd Floor, PO Box 95026
Lincoln, NE 68509-5026
Phone: (402) 471-2135
https://medicaiddirectors.org/wp-content/uploads/2023/06/Public_DirectorsList_June2023-1.pdf
General Genetic Testing Criteria
Genetic Testing Not Covered
A full list of non covered genetic tests can be found in the fee schedule.
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
A Genetic Counselor is a person who has (1) met the requirements established by the national genetic counseling board to take the national certification examination in general genetics or genetic counseling and (2) been granted active candidate status by the national genetic counseling board.
The Genetic Counselor is licensed to practice within the scope of genetic counseling under the Uniform Credentialing Act and as described within 38-3415.
License Application: https://dhhs.ne.gov/licensure/Documents/GeneticCounsAppWOAdminPenalty.pdf
Metabolic Formula Coverage Legislation
Nebraska Statute 71-519
Metabolic Formula Coverage & Criteria
The Department of Health and Human Services shall establish a program to provide food supplements and treatment services to individuals suffering from the inherited or congenital infant or childhood-onset diseases set forth in section 71-519. To defray or help defray the costs of any program which may be established by the department under this section, the department may prescribe and assess a scale of fees for the food supplements. The maximum prescribed fee for food supplements shall be no more than the actual cost of providing such supplements. No fees may be charged for formula, and up to two thousand dollars of pharmaceutically manufactured food supplements shall be available to an individual without fees each year. For purposes of this section, pharmaceutically manufactured foods are chemically synthesized or processed for the treatment of inborn errors in metabolism.
Prior Authorization Requirements
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Yes, coverage is available.
Requirements for BRCA
- For BRCA1, BRCA2 (Breast Cancer 1 AND 2) (EG, Hereditary breast and ovarian cancer) gene analysis: limit one per lifetime; documentation required-must have history of breast, ovarian, or fallopian tube cancer.
- For BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant: limit one per lifetime; documentation required
- For BRCA2 (breast cancer 2) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant: limit one per lifetime; documentation required; must have history of breast, ovarian, or fallopian tube cancer
Cystic Fibrosis Screening
Coverage is available, but criteria is unknown.
Hereditary Cancer Testing Coverage
Coverage is available, but criteria is unknown.
Lynch Syndrome Testing Coverage
Coverage is available, but criteria is unknown.
Microarray Testing
Limited coverage is available. Criteria is unknown.
Newborn Screening
The private laboratory charges the hospital $86. Most insurers, including Medicaid, cover the cost of newborn screening testing as part of the obstetric diagnostic related group charge. Hospital fees for collection and handling of the specimen vary, and are not regulated by the State Newborn Screening Program.
Panel Testing
Listed covered panels include:
- Genomic sequence analysis panel of at least 6 genes associated with drug metabolism
- Gene sequence analysis panel at least 30 genes associated with inherited bone marrow
- Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes
Pharmacogenetic Testing
Coverage is available, but criteria is unknown.
Prenatal Testing Offered
No coverage offered.
Whole Exome Sequencing
Other Tests Covered
For a full list of genetic testing covered, see the fee schedule.
Other Information
Resources
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.