MedicaidPrior AuthMedium impact
MMP 23-19: Updates to Genetic and Molecular Testing Standards of Coverage; Updates to Medicaid Coverage of Noninvasive Prenatal Testing; and Waiver of Out-of-State Provider Prior Authorization Requirement for Genetic Testing Laboratories
Michigan Medicaid - MDHHS·MI · Genetics, OB-GYN·Prior Authorization
Effective date
May 1, 2023
We identified it
Jun 20, 2026
Summary
Michigan Medicaid updated genetic and molecular testing coverage standards, expanded noninvasive prenatal testing (NIPT) coverage to all pregnant beneficiaries regardless of age/risk factors, and waived prior authorization requirements for out-of-state genetic testing laboratories. NIPT no longer requires prior authorization when performed by Medicaid-enrolled labs.
Action Required
By May 1, 2023: Billing team must update prior authorization workflows to remove PA requirements for NIPT screening when performed by Medicaid-enrolled laboratories. Update system to allow NIPT coverage for all pregnant beneficiaries at 10+ weeks gestation regardless of age/risk factors, limited to once per pregnancy. For out-of-state genetic testing labs, verify Clinical Laboratory Certified-Genetic Testing specialty designation in CHAMPS enrollment to qualify for PA waiver while maintaining other clinical PA requirements.