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General Approach to Genetic Testing
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Family Medicine, Internal Medicine +4 more·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has established a comprehensive framework for evaluating genetic testing medical necessity across 4 categories: symptomatic individual testing, cancer cell testing, asymptomatic risk testing, and family benefit testing. All genetic testing must meet specific criteria including reduced life expectancy or moderate-to-severe morbidity, with detailed requirements for diagnostic, prognostic, and therapeutic subcategories.
Action Required
Immediately: Billing team must review all genetic testing claims against the new 4-category framework before submission. Ensure all genetic tests meet the specific criteria for their category (diagnostic, prognostic, or therapeutic) and document that the condition being tested has either reduced life expectancy or moderate-to-severe morbidity. Update prior authorization workflows to verify clinical utility has been established for each genetic test. Claims not meeting the detailed criteria will likely be denied.