North Dakota
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
Caprice Knapp, Director of HHS North Dakota Department of Human Services
600 E Boulevard Ave, Dept 325
Bismarck, ND 58505-0250
(701) 328-7068
General Genetic Testing Criteria
ND Medicaid follows the Local Coverage Determination (LCD) L24308 published by Noridian Healthcare Solution, for genetic testing. Prior authorization must be obtained for any genetic testing (Tier 1 or Tier 2 molecular pathology) that falls outside the scope of this LCD.
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
Metabolic Formula Coverage Legislation
Provision of Medical Food and Low-Protein Modified Food Products to Individuals with Phenylketonuria and Maple Syrup Urine Disease
Metabolic Formula Coverage & Criteria
Provision of Medical Food and Low-Protein Modified Food Products to Individuals with Phenylketonuria and Maple Syrup Urine Disease
Prior Authorization Requirements
Prior authorization requirements include:
- Patient diagnosis or clinical indication (ICD-9 code) or (ICD-10 code) after October 1, 2015;
- Test ordered (CPT code or test name);
- Indication/reason for test;
- Signs, symptoms, and duration;
- Prior related diagnostic and/or genetic tests and their results;
- Laboratory studies and results;
- Family medical/genetic history;
- Medications and duration (if related);
- Prior treatments or other clinical findings (when relevant); and
- How the test results will be utilized in the member’s care.
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Coverage is available.
Requirements for BRCA
Requires Service Authorization and is limited to members with a personal history of malignancy.
Cystic Fibrosis Screening
Hereditary Cancer Testing Coverage
Some conditions are covered.
Lynch Syndrome Testing Coverage
Yes, with prior authorization.
Microarray Testing
Newborn Screening
Panel Testing
Pharmacogenetic Testing
Pharmacogenetic panel tests for therapy selection, such as panel tests for psychotropic, analgesics or ADHD stimulant medications is listed as a non covered service by the General Information for Providers maunal 2021.
Prenatal Testing Offered
Whole Exome Sequencing
Other Tests Covered
Other Information
Special Health Services provides:
- Medical food and low-protein modified food products to individuals with Phenylketonuria (PKU) and Maple Syrup Urine Disease (MSUD);
- Medical food at no cost to males under age 26 and females under age 45 who are diagnosed with PKU or MSUD, regardless of income;
- For sale at cost medical food to males age 26 and over and females age 45 and over who are diagnosed with PKU or MSUD, regardless of income;
- Low-protein modified food products, if medically necessary as determined by a qualified health care provider, to males under age 26 and females under age 45 who are receiving medical assistance and are diagnosed with PKU or MSUD.
Resources
- Durable Medical Equipment Provider Manual (November 2019)
- General Information for Providers Manual (April 2021)
- https://www.nd.gov/dhs/services/medicalserv/medicaid/provider-all.html
- Provider Bulletin Issue 72 August 2015
- http://www.nd.gov/dhs/info/pubs/docs/medicaid/issue72-aug2015.pdf
- Form SPN 527
- http://www.nd.gov/dhs/info/pubs/docs/medicaid/issue74-june2018.pdf
Newborn Screening Reimbursement
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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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