GeneDx is a registered provider with the Medicaid plans listed below. Although GeneDx is a registered provider with these plans, most of them do not cover genetic testing. Prior-authorization is required by most of the Medicaid plans. Many plans only have coverage for specific tests. Therefore, please contact GeneDx or your State Medicaid plan to find out if specific tests are covered under the approved services. In an instance where we receive a Medicaid sample without a prior authorization for a Medicaid plan which requires a PA, the test will go on hold and not proceed in the lab.
New Mexico Medicaid
New York Medicaid
North Carolina Medicaid
|North Dakota Medicaid
South Carolina Medicaid
Washington D.C. Medicaid
West Virginia Medicaid
GeneDx is contracted as an in-network provider with Medicare. Currently Medicare has published criteria for Hereditary Breast and Ovarian Cancer (HBOC) and Hereditary Colorectal Cancer/Lynch Syndrome. Please refer to our Medicare Criteria Form to determine if your patient meets the necessary criteria to get coverage for hereditary cancer genetic testing. If the patient does not meet Medicare’s pre-determined criteria, a completed Advance Beneficiary Notice (ABN) is required. For all other non hereditary cancer genetic testing, an ABN is required.
Our customer service department will reach out to the physician to obtain a completed ABN if:
- A patient does not meet criteria and a sample is received without an ABN
- An ABN is incomplete and requires additional information