Genetic Testing for Diagnosis of Inherited Conditions - MEDICAID - VIRGINIA

This Virginia Medicaid policy covers genetic testing of an individual’s DNA to confirm diagnosis or guide treatment of inherited conditions, including targeted/focused multigene panels and tests for disorders such as hemophilia (F9/F8), mitochondrial disorders, hematologic malignancies, hereditary ataxias (eg, CANVAS, DRPLA), coagulation/thrombophilia disorders, optical genome mapping, and POC fetal aneuploidy STR analysis. Major limitations/requirements: only listed tests/indications are eligible and many assays are considered investigational/not covered (eg, rapid/ultrarapid WGS/WES, certain whole mitochondrial genome panels, PGT‑A, twin zygosity); specified CPT/HCPCS codes must be used, deletion/duplication results billed separately, nuclear‑encoded mitochondrial panels must contain ≥100 genes, and POC STR testing is limited to fetal DNA from products of conception.

"Glycogen storage disease type I (reference: NCBI Genetic Testing Registry)."