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Oregon Health Plan (Medicaid) Coverage of Genetic Testing
The Oregon Health Services Commission has established Practice Guidelines for coverage of genetic testing. There are specific guidelines for genetic testing for inherited breast and ovarian cancer, inherited colorectal cancer, and for infants and children with developmental delay. Coverage for other genetic tests is determined by the Non-prenatal Genetic Testing Algorithm. These guidelines do not apply to prenatal genetic testing.
 
The guidelines are included in the Prioritized List of Health Services document posted on the Oregon Health Plan website. To get to the most recent version of the Prioritized List of Health Services, go to http://www.oregon.gov/oha/OHPR/pages/herc/current-prioritized-list.aspx. Then click through the links: OHP Prioritized List, then Current Prioritized List, then on the Prioritized List of Health Sciences.
 
The genetic testing Practice Guidelines apply to all Medicaid clients.

Health care providers can contact Isabel Bickle, 503-945-6490, Isabel.Bickle@state.or.us, for policy questions about coverage of genetic tests and Provider Services at 1-800-336-6016 about billing issues.
 
OHP clients should talk to their health care provider if they have questions about coverage of specific genetic tests.