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Does Medicare Cover Genome Sequencing?

Maya Lin-Takahashi • • 6 min read
Does Medicare Cover Genome Sequencing?

Medicare will cover next-generation sequencing (NGS) tests for people with any stage of female breast or ovarian cancer to determine if they have hereditary cancer

hereditary cancer
A cancer syndrome, or family cancer syndrome, is a genetic disorder in which inherited genetic mutations in one or more genes predispose the affected individuals to the development of cancers and may also cause the early onset of these cancers.
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-associated mutations, according to a Jan. 27, 2020, decision memo from the Centers for Medicare & Medicaid Services (CMS).

Does Medicare pay for genomic testing?

Medicare has limited coverage of genetic testing for an inherited genetic mutation. Medicare covers genetic testing for people with a cancer diagnosis who meet certain criteria; you must have a cancer diagnosis to qualify for coverage of genetic testing for an inherited mutation under Medicare.

Does Medicare cover next-generation sequencing?

PURPOSE: In 2018, Medicare issued a national coverage determination (NCD) providing reimbursement for next-generation sequencing (NGS) tests for beneficiaries with advanced or metastatic cancer and no previous NGS testing.

Maya Lin-Takahashi
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Maya Lin-Takahashi

Maya is a hardware enthusiast who tests and reviews smart home devices, smartphones, wearables, and audio gear. She focuses on practical consumer value and build quality.