Reimbursement

Both consumers and health care providers often have questions about financing genetic services. Families may want to know whether a clinic visit or testing is covered by their insurance. They may need to find programs that help cover the special health needs of a loved one with a genetic condition or birth defect. Providers face issues related to collecting reimbursement for their services. This page includes some state as well as federal resources on reimbursement for both consumers and health care providers. Genetic testing, when medically indicated, is often covered by health insurance. Please check directly with your own health insurance provider to find out which genetics related services are covered by your health plan.

MEDICAID is health care coverage for low-income families and individuals. This includes families with children, pregnant women, and persons under the age of 21. It also offers help to the blind and disabled, and people age 65 and over.

Other state health care programs may be available to help cover the cost of diagnostic or treatment services for individuals with, or at risk for, birth defects or genetic conditions based on eligibility criteria.

Remember to check with your own health insurance provider to see which genetic services are covered!

MICHIGAN MEDICAID PROGRAM is a source for billing and reimbursement, forms publication, and other information.

CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS) - DIAGNOSIS CODE 2003 LISTING covers about 2,600 medical diagnoses that are handicapping in nature and require care by a medical or surgical subspecialist. Diagnosis alone does not guarantee medical eligibility for CSHCS.

The Michigan MEDICAID PROVIDER MANUAL provides instructions for billing and reimbursement, copies of pertinent forms, and gives contact information for applicable offices and agencies. In addition, evaluation criteria regarding the level of severity, chronicity, and the need for annual medical care and treatment by a physician subspecialist are described in the CSHCS Chapter, Section 8.1 Medical Renewal Period.

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Programs for which CMS is responsible include MEDICARE, MEDICAID, and STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) .