Does Medicare Cover Genetic Testing?

Currently, Medicare does not cover genetic testing in most cases. However, there are some exceptions to this rule with BRCA1 and BRCA2 genes. Learn more about these exceptions below.

Does Medicare Cover BRCA Testing?

Medicare does pay for genetic testing and genetic counseling for the BRCA1 and BRCA2 genes in some circumstances. These genes, when mutated or altered, are associated with an increased risk for breast cancer and ovarian cancer. 

Medicare will likely cover BRCA testing if you have a history of breast cancer and at least one of the following pertains to you:¹

• You were diagnosed at or before age 45, with or without a family history of the disease.
• You have had two breast primaries when the first cancer diagnosis came before age 50.
• You have had a personal history of epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer.
• You have a close male blood relative with a history of breast cancer.
• You are of an ethnicity with higher mutation frequency.
• You have a close blood relative with a BRCA1 or BRCA2 gene mutation.

Covered Screenings

Though Medicare's coverage of genetic tests is limited, the federal insurance program does cover other forms of preventive medicine, including some cancer screenings. Some of the cancer screenings that may be covered by Medicare include:

• Lung cancer screening
• Mammograms
• Prostate cancer screenings
• Cervical and vaginal cancer screenings

These screenings, which are covered under Medicare Part B, can help you seek necessary treatment, while taking steps to keep yourself healthy. Even with coverage, however, there are some out-of-pocket expenses that you should be prepared to pay, including a Part B coinsurance and a Part B deductible.

Learn more about Medicare coverage of common procedures.

ICD 10 Code for Family History of Breast Cancer

The ICD-10 Codes for a family history of malignant neoplasm in the breast is Z80.3.

¹ http://www.facingourrisk.org/understanding-brca-and-hboc/information/finding-health-care/paying_for_testing/basics/medicare_and_genetic_testing.php#text