Breast and Cervical Cancer (BRCA) Genetic Mutation Testing

Revised: January 1, 2026

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Billing

· Legal References

Overview

Minnesota Health Care Programs (MHCP) covers genetic testing for breast and cervical cancer for Medical Assistance and MinnesotaCare members who meet the required criteria.

Eligible Providers

· Advanced practice registered nurses

· Clinics

· Outpatient hospital departments

· Physician assistants

· Physicians

Eligible Members

All Medical Assistance (MA) and MinnesotaCare members are eligible if they meet the criteria under covered services.

Covered Services

BRCA Genetic Mutation Testing for Breast and Ovarian Cancer Susceptibility
Effective Jan. 1, 2026, BRCA genetic mutation testing for breast and ovarian cancer does not require prior authorization. However, the following criteria must be met for testing coverage:

1. The member has been found to have either of the following based on an appropriate brief familial risk assessment tool:

· Family history of breast, ovarian, tubal, or peritoneal cancer

Or

· Have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA ½) gene mutations

2. The member must receive genetic counseling either before or after genetic testing

Noncovered Services

Refer to MHCP Noncovered Services in Health Care Programs and Services under Provider Basics in the MHCP Provider Manual for all noncovered services.

Billing

Refer to Billing Policy Overview under Provider Basics in the MHCP Provider Manual for billing requirements.

You must be an enrolled MHCP provider to bill for and receive payment.

We reimburse at the MHCP allowed rate for covered Medical Assistance services only.

Legal References

Minnesota Statutes 256B.057, subdivision 10
Minnesota Statutes 256B.0625, subdivision 13