Summary
This guide outlines the requirements and procedures for genetic testing under Idaho Medicaid. It specifies the need for prior authorization and directs users to consult the Idaho Medicaid Fee Schedule and the Provider Handbook for detailed information. Required documentation includes a signed Requisition/Attestation form and evidence of medical necessity, detailing how test results will significantly impact medical care. The guide lists genetic tests that are not covered by Idaho Medicaid, including tests performed solely for screening, diagnosis confirmation, or for legal reasons. Additionally, it emphasizes the necessity of genetic counseling provided by qualified professionals. The document also addresses pharmacogenetic testing, stating that coverage is contingent upon the testing being required or recommended by prescribing information. It mentions auto-approvals for certain genetic testing codes, highlighting the importance of selecting the correct indication and ensuring documentation aligns with Idaho Medicaid’s criteria.
