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 301 Centennial Mall South
Lincoln, Nebraska 68509
(402) 471-3121
General Genetic Testing Criteria
Medicaid considers genetic testing medically necessary when the results impact the clinical decision making process for the patient. It must be demonstrated that genetic testing is essential for necessary medical intervention. If genetic testing is for diagnosis only, or for medical management of family members, Medicaid will not approve payment for the service. (See the following: Title 471 Nebraska Administrative Codes 10-004.04, 10-004.05, 10-004.05A, and 18-003.04)
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
Metabolic Formula Coverage Legislation
Nebraska Revised Statute 71-520.
Food supplement and treatment services program; authorized; fees.
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.
Metabolic Formula Coverage & Criteria
Nebraska Revised Statute 71-520.
Food supplement and treatment services program; authorized; fees.
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
Nebraska Medicaid does not require prior authorization for genetic testing.
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Certain genetic tests are covered.
Requirements for BRCA
Cystic Fibrosis Screening
Hereditary Cancer Testing Coverage
Coverage is available.
Lynch Syndrome Testing Coverage
Coverage is available.
Microarray Testing
Newborn Screening
Panel Testing
Most panel tests listed as non covered services according to the fee schedule.
Pharmacogenetic Testing
Prenatal Testing Offered
No coverage is available.
Whole Exome Sequencing
Other Tests Covered
Other Information
Resources
- DME, Medical Supplies, Orthotics & Prosthetics handbook
- http://dhhs.ne.gov/Pages/MLTC-PH-DME.aspx
- Provider Bulletin: Clarification of Payment for Genetic Testing
- http://dhhs.ne.gov/Medicaid%20Provider%20Bulletins/Provider%20Bulletin%2011-11.pdf#search=genetic
- Metabolic Formula Coverage
- https://nebraskalegislature.gov/laws/statutes.php?statute=71-520
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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