All PlansCoverageMedium impact
Genetic Testing
Blue Cross & Blue Shield of Mississippi·MS · Family Medicine, Internal Medicine, Pediatrics +11 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi has updated their genetic testing medical policy (L.2.04.409) which outlines comprehensive criteria for when genetic tests are considered medically necessary versus investigational. The policy establishes specific requirements including that members must display clinical features or be at direct risk, test results must directly impact treatment, and conventional diagnostic studies must be inconclusive.
Action Required
Immediately: Review all pending and future genetic testing prior authorization requests to ensure they meet the three-criteria requirement: (1) member displays clinical features or is at direct risk of inheriting the mutation, (2) test results will directly impact treatment, and (3) conventional diagnostic studies have been completed but diagnosis remains uncertain. Update prior authorization workflows to verify these criteria are documented before submission. For the extensive list of covered genetic conditions, refer to specific linked policies when available as they may have additional requirements.