| Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | Physician | | 02/16/2025 | Prior Authorization : Prior Authorization GuidelinesTopic #16997 Genetic Testing
When submitting a PA request for genetic testing, providers are required to submit both the PA/RF and the PA/PA. The maximum allowable fee schedule indicates which genetic testing services require PA.
For services requiring PA, in situations where published guidelines are not available or are inconclusive, Wisconsin Medicaid and BadgerCare Plus will request that additional information be provided with the PA request, such as peer-reviewed journal articles or published studies, as evidence of the medical necessity of a particular test. |