MedicaidPrior AuthMedium impact
Genetic Testing for Breast and Ovarian Cancer FAP and Lynch Syndrome - MEDICAID - LOUISIANA (Revised)
Humana·LA · Genetics, Oncology, Gastroenterology +3 more·Medicaid
Effective date
Jan 20, 2025
We identified it
Jun 24, 2026
Summary
New Medicaid policy establishes coverage criteria for genetic testing for breast/ovarian cancer (BRCA1/BRCA2), familial adenomatous polyposis (APC gene), and Lynch syndrome. All genetic testing now requires prior authorization and mandatory genetic counseling before and after testing.
Action Required
Before January 20, 2025: Billing team must update prior authorization requirements for all genetic testing claims for Louisiana Medicaid patients. Ensure genetic counseling is documented in medical records before and after testing, including structured family history, genetic risk assessment, and counseling documentation. Verify patients meet specific clinical criteria outlined in policy before submitting claims to avoid denials.