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Genetic Counseling Requirement for BRCA Testing Will Change on August 1, 2024, for Texas Medicaid

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after August 1, 2024, the genetic counseling requirement for breast cancer (BRCA) gene mutation testing will change for Texas Medicaid: Providers that perform genetic counseling may be affiliated with the genetic testing laboratory.

For more information, call the TMHP Contact Center at 800-925-9126.