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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Genetics, PediatricsMedium impact

Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Chromosomal microarray (CMA) testing may be considered medically necessary as first-line testing in the initial evaluation of individuals with apparent nonsyndromic developmental delay or intellectual disability, autism spectrum disorder, or multiple congenital anomalies not specific to a well-delineated genetic syndrome. CMA is considered investigational for all other conditions of delayed development, including idiopathic growth or language delay. Panel testing using next-generation sequencing is considered investigational in all cases of suspected genetic abnormality in children with developmental delay or intellectual disability, autism spectrum disorder, or congenital anomalies, and CMA testing is not intended for use in the prenatal period.

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What to do

Action · 6 steps
01Billing team: Before billing CMA for a child, confirm the chart supports apparent nonsyndromic developmental delay or intellectual disability, autism spectrum disorder, or multiple congenital anomalies not specific to a well-delineated genetic syndrome, because CMA is medically necessary as first-line testing only for those indications.
02Do not bill CMA as medically necessary for other conditions of delayed development, such as idiopathic growth or language delay, and do not bill CMA for prenatal testing.
03Do not bill panel next-generation sequencing for suspected genetic abnormality in children with these conditions as medically necessary, since the policy considers it investigational.
04Covered codes are only medically necessary when the procedure is performed according to the policy section, and BCBSMS makes no payment for services not documented to be medically necessary.
05Genetic counseling should be performed by an individual with experience and expertise in genetic medicine and genetic testing methods.
06The ACMG recommends follow-up of any chromosome imbalance identified by CMA with cytogenetic or FISH studies, parental evaluation, and clinical genetic evaluation and counseling.

Codes mentioned

81228812298147081471S3870F84.0F80.0F82F88F89G11.5H93.25Q87.83Q87.84Q87.85Q93.52

Original notice

Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies
bcbsms.com · Always check the source before changing claims.
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Related changes

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Invasive Prenatal (Fetal) Diagnostic TestingMediumNo effective date · Medical PolicyGenetic Testing for FMR1 Variants (including Fragile X Syndrome)MediumNo effective date · Medical PolicySpeech TherapyMediumEffective Jan 1, 2021 · Medical PolicyTreatment of Autism Spectrum Disorder (ASD)MediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesGeneticsPediatricsCode 81228Code 81229Code 81470Code 81471Code S3870Code F84.0Code F80.0Code F82Code F88Code F89Code G11.5Code H93.25Code Q87.83Code Q87.84Code Q87.85Code Q93.52

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