MedicaidCoverageMedium impact
Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Genetics, Neurology, Pediatrics +1 more·Medicaid
Effective date
Apr 1, 2025
We identified it
Jun 24, 2026
Summary
Humana South Carolina Medicaid has established new coverage criteria for genetic testing to diagnose inherited conditions, including specific requirements for conditions like adrenoleukodystrophy, cerebellar ataxia, corneal dystrophy, and muscular dystrophies. The policy requires pre- and post-test genetic counseling and specific clinical criteria to be met for coverage approval.
Action Required
By April 1, 2025: Billing team must review genetic testing orders for South Carolina Medicaid patients to ensure they meet the specific coverage criteria outlined in policy HUM-2109-002. Verify that pre- and post-test genetic counseling is documented and that clinical criteria are met for each covered condition before submitting claims. Update prior authorization processes to include the detailed clinical requirements for conditions like adrenoleukodystrophy, CANVAS, and muscular dystrophies.