All PlansCoverageMedium impact
Carrier Screening for Genetic Diseases
Blue Cross & Blue Shield of Mississippi·MS · OB-GYN, Family Medicine, Internal Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
This new policy establishes medical necessity criteria for genetic carrier screening tests, including both targeted risk-based screening and non-targeted screening panels. The policy specifies coverage requirements for individuals who are pregnant or considering pregnancy, with different criteria based on risk factors and family history.
Action Required
Immediately: Billing team must review all genetic carrier screening claims to ensure they meet the new medical necessity criteria before submission. Update prior authorization processes to verify patients meet risk-based criteria (family history, known carrier status, or high-risk population membership) for targeted screening, or general pregnancy/preconception criteria for non-targeted panels. Train staff to identify when genetic testing policy supersedes this carrier screening policy. Claims not meeting criteria will be considered investigational and denied.