Library: Policy

317:30-5-221. Coverage

Revised 2-21-23

(a) Genetic counseling services are covered for SoonerCare members who meet the criteria for receiving medically necessary genetic testing as set forth in 317:30-5-2 (a)(1)(FF) and for pregnant/postpartum SoonerCare members as set forth in this section. Services for pregnant/postpartum SoonerCare members must be referred by a provider involved in the provision of obstetric or pediatric care.  Members are eligible for genetic counseling during pregnancy which includes twelve (12) months postpartum.  Reasons for genetic counseling include but are not limited to the following:

(1) Advanced maternal age;

(2) Abnormal maternal serum first or second screening;

(3) Previous child or current fetus/infant with an abnormality;

(4) Consanguinity/incest;

(5) Parent is a known carrier or has a family history of a genetic condition;

(6) Parent was exposed to a known or suspected reproductive hazard;

(7) Previous fetal demise, stillbirth, or neonatal death involving known/suspected abnormalities;

(8) History of recurrent pregnancy loss; or

(9) Parent(s) are in an ethnic or racial group associated with an increased risk for specific genetic conditions.

(b) These services may be provided in an office or outpatient setting.