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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/31/2024

 

To: All Medical Assistance Program Providers
​Date December 31, 2024
​Re:
 Confirmation of Genetic Testing Coverage per Public Act 103-0914

This notice confirms the Department of Healthcare and Family Services’ (HFS) coverage for genetic testing and evidence-based screenings for an inherited gene mutation. This coverage is required under Public Act 103-0914 and applies to the Medicaid fee-for-service program and the managed care organizations (MCOs).

In accordance with the Act, for dates of service beginning January 1, 2025, HFS will ensure coverage for clinical genetic testing for an inherited gene mutation for individuals with a personal or family history of cancer, as recommended by a health care professional in accordance with current evidence-based clinical practice guidelines.

HFS already covers certain genetic testing codes but will open additional codes for reimbursement in compliance with the Act. Below are the additional codes to be covered effective with dates of service beginning January 1, 2025. They will be included in a later update to the Practitioner Fee Schedule. Any additional future coding changes will be identified in the Practitioner Fee Schedule.

 

Genetic Testing Procedure Codes Added Effective 1/1/2025

0101U

0162U

0102U

0238U

0103U

0340U

0129U

81422

0130U

81432

0131U

81433

0132U

81436

0133U

81437

0134U

81438

0135U

 


Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable MCO.

                                 

Kelly Cunningham, Administrator
Division of Medical Programs