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December 2016 Texas Medicaid Provider Procedures Manual

Radiology and Laboratory Services Handbook : 2 Independent Laboratory : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.6 Breast Cancer Gene 1 and 2 (BRCA) Testing : 2.2.6.2 Documentation

2.2.6.2
Providers must maintain the following gene mutation analysis testing documentation in the client’s medical record:
The client’s ability to understand the risks, benefits, and limitations and the client’s informed choice to proceed with the specific gene mutation analysis testing as evidenced by the client’s signature on a consent form specific to the genetic mutation testing to be performed.
The client’s BRCA1 and BRCA2 comprehensive gene mutation analysis testing results to support medical necessity for BRCA large rearrangement gene mutation analysis testing
The medical record is subject to retrospective review.

Texas Medicaid & Healthcare Partnership
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