MedicaidCoverageMedium impact
Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - VIRGINIA (Revised)
Humana·VA · Genetics, Neurology, Pediatrics +2 more·Medicaid
Effective date
Mar 9, 2026
We identified it
Jun 24, 2026
Summary
Humana Virginia Medicaid updated genetic testing coverage criteria for inherited conditions, establishing specific diagnostic requirements for conditions like adrenoleukodystrophy, CANVAS, muscular dystrophies, and other genetic disorders. The policy requires pre- and post-test genetic counseling and specific clinical criteria to be met for coverage.
Action Required
Before March 9, 2026: Billing team must review genetic testing claims for Virginia Medicaid members to ensure they meet the new specific diagnostic criteria outlined in policy HUM-2109-002. Update prior authorization workflows to verify pre- and post-test genetic counseling requirements and clinical criteria for conditions like adrenoleukodystrophy, CANVAS, muscular dystrophies, and other inherited conditions. Claims not meeting the specified criteria will likely be denied.