Virginia

Updated on March 28, 2023

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

Unknown

State Contact Information

Cheryl Roberts
Deputy Director of Programs and Operations

General Genetic Testing Criteria

Genetic Testing Not Covered

State Specific Definition

Genetic Services for Children

Genetic Counseling Requirement

Metabolic Formula Coverage Legislation

Metabolic Formula Coverage & Criteria

Prior Authorization Requirements

Prior Authorization Forms

https://www.dmas.virginia.gov/for-providers/general-information/service-authorization/

Fee Schedule

https://www.dmas.virginia.gov/for-providers/rates-and-rate-setting/procedure-fee-files-cpt-codes/

BRCA Testing Coverage

Requirements for BRCA

Cystic Fibrosis Screening

Hereditary Cancer Testing Coverage

Lynch Syndrome Testing Coverage

Microarray Testing

Newborn Screening

<p>Coverage is available for children to include both screening and blood lead tests as appropriate, based on age and risk factors. In addition to the lead toxicity screening, the following procedures on laboratory tests are required:</p> <ol> <li>Neonatal Screening; and</li> <li>Sickle Cell Screening.</li> </ol>

Panel Testing

Pharmacogenetic Testing

Prenatal Testing Offered

Whole Exome Sequencing

Other Tests Covered

Other Information

Sickle Cell Screening Program: Sickle cell screening is offered through local Health Departments in both family planning and maternity clinics. We encourage parents whose newborn has been identified with sickle cell disease or trait to be tested. To see if you qualify for free screening, please contact your local health department.

Resources

  • Provider Manual Durable Medical Equipment and Supplies Manual Chapter IV Covered Services and Limitations
    • https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManual
  • Sickle Cell Screening Program
    • http://www.vdh.virginia.gov/sickle-cell-programs/services/
  • https://www.ecm.virginiamedicaid.dmas.virginia.gov/WorkplaceXT/getContent?impersonate=true&id=%7BB00CF05C-0000-C420-831D-F6883978FBA0%7D&vsId=%7BAE8AE2CE-115A-49A8-BA43-8534F3123152%7D&objectType=document&objectStoreName=VAPRODOS1
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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