New Texas Medicaid Genetic Testing Policy for October 2025

Date: October 7, 2025

Attention: Providers

Effective date: October 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the Health and Human Services Commission (HHSC) has created an overarching policy for genetic testing benefits for Texas Medicaid clients. The new Genetic Testing policy language can be found in the Radiology and Laboratory Services Handbook in the Texas Medicaid Provider Procedures Manual effective October 1, 2025.

Please note that existing standalone genetic testing policies such as the Breast Cancer Gene 1 and 2 (BRCA) Testing, Cytogenetics Testing, Noninvasive Prenatal Screening (NIPS), etc. will continue to remain discrete and distinct policies.

How this impacts providers:

More information on the new policy is as follows.

• The new Genetic Testing Medicaid policy establishes general overarching policy language for fee-for-service genetic testing benefits where standard benefit statements including medical necessity, prior authorization, restriction/limitation, billing, documentation, claim processing, etc. are located.
• This policy also captures certain existing genetic testing benefits that are currently listed only in the Texas Medicaid fee schedule but are without existing benefit language.
• This policy does not add new benefit coverage.
• This policy will serve as a general location for future genetic testing benefit language that may not require an independent policy.

Next step for Providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org. 

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.