All PlansCoverageLow impact
Genetic Testing for Rett Syndrome
Blue Cross & Blue Shield of Mississippi·Pediatrics, Neurology, Family Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
New medical policy establishes coverage criteria for genetic testing for Rett syndrome-associated genes (MECP2, FOXG1, CDKL5). Testing is considered medically necessary for children with developmental delay and Rett syndrome symptoms when genetic testing is needed for definitive diagnosis, and for carrier testing of first-degree female relatives of affected individuals.
Action Required
Immediately: Billing team should review claims for Rett syndrome genetic testing to ensure proper documentation of developmental delay and Rett syndrome symptoms is present before submitting. Verify that testing requests meet the medical necessity criteria outlined in policy L.2.04.461. Claims for routine carrier testing or asymptomatic family member testing should be flagged as investigational and likely to be denied.