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


State Contact Information

Jan Stall, Department of Health
401 Hathaway Building
Cheyenne, WY 82002

General Genetic Testing Criteria

There is reasonable expectation based on family history, risk factors, or symptomatology that a genetically inherited condition exists; and

  1. Test results will influence decisions concerning disease treatment or prevention; and
  2. Genetic testing of children might confirm current symptomatology or predict adult onset diseases and findings might result in medical benefit to the child or as the child reaches adulthood; and
  3. Referral is made by a genetic specialist (codes 81223 and 81224) or a specialist in the field of the condition to be tested; and
  4. All other methods of testing and diagnosis have met without success to determine the client’s condition such that medically appropriate treatment can be determined and rendered without the genetic testing.

Genetic Testing Not Covered

State Specific Definition

Genetic Services for Children

Genetic Counseling Requirement

Medicaid covers appropriate genetic counseling when it is provided in conjunction with performance or consideration of medically necessary BRCA testing that meets the criteria listed above. This includes follow-up genetic counseling to discuss the results of these tests. Three (3) 30 minute units (for a total of 90 minutes) are allowed per day.
Physician specialties that may bill for BRCA genetic counseling are:

  1. Clinical genetics;
  2. Family practice;
  3. OB/GYN;
  4. Internal medicine;
  5. Internal medicine, medical oncology; or
  6. General surgery

Metabolic Formula Coverage Legislation

Metabolic Formula Coverage & Criteria

Prior Authorization Requirements

Prior Authorization is required for all genetic testing codes.

Prior Authorization Forms


Fee Schedule


BRCA Testing Coverage

Coverage is available.

Requirements for BRCA

BRCA testing is covered when criteria are met:

  1. Personal and/or family history of breast cancer, especially if associated with young age of onset; OR
  2. Multiple tumors; OR
  3. Triple-negative (i.e., estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2-negative) or medullary histology; OR
  4. History of ovarian cancer; AND
  5. 18 years or older; AND
  6. Documentation indicates a genetic counseling visit pre or post testing.

Cystic Fibrosis Screening

Hereditary Cancer Testing Coverage

Some familial gene variants are covered.

Lynch Syndrome Testing Coverage

Coverage is available.

Microarray Testing

Newborn Screening

Panel Testing

Pharmacogenetic Testing

Prenatal Testing Offered

Mother must be documented as high-risk to include:

  1. Advanced maternal age >35 (at EDC);
  2. Previous “birth” of embryo/fetus/child with aneuploidy
  3. Parent with known balanced translocation, screen positive on standard genetic screening test (FTCS, multiple marker screen of one type or another, etc), ultrasound finding on embryo/fetus consistent with increased risk of aneuploidy.

Whole Exome Sequencing

Other Tests Covered

Other Information


  • Medicaid Provider Manual Laboratory Services Medicaid Provider Manual DME Covered Services CMS-1500 Provider Manual (Effective 7.1.21)
Newborn Screening Reimbursement


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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