Medicare covers genetic testing when it's a medically necessary diagnostic lab test your provider orders. For gene sequencing specifically, the national rule is NCD 90.2, and it reaches only cancer testing, with a checklist a patient has to clear. If your doctor just mentioned a genetic test, whether it clears that checklist is the question that matters.

In This Guide

Does Medicare Cover Genetic Testing? The Short Answer

Medicare covers genetic testing when it's a medically necessary diagnostic laboratory test your health care provider orders, meaning your doctor is using it to figure out or manage a condition you already have. Medicare also covers some preventive tests and screenings. Which of those descriptions your test fits is the whole ballgame.

The clearest example is cancer. Medicare covers a category of genetic test called Next-Generation Sequencing for certain cancer patients, and we'll walk through exactly who qualifies below. What that national coverage doesn't reach is a panel no treating physician ordered, or a test for someone with no cancer diagnosis behind it.

What Genetic Tests Medicare Covers

The main pathway is a national rule called National Coverage Determination (NCD) 90.2, which the Centers for Medicare & Medicaid Services uses to cover Next-Generation Sequencing (NGS), a type of genetic test that reads large stretches of DNA at once. Under Part B, Medicare covers NGS as a diagnostic laboratory test for people with cancer when a treating physician orders it and the test runs in a CLIA-certified lab. The NCD applies only to diagnostic lab tests using NGS for somatic (acquired) and germline (inherited) cancer.

There are two situations here, and they work a little differently.

Somatic testing reads the DNA of the tumor itself, the mutations a cancer picked up along the way. Medicare covers it nationally, for services performed on or after March 16, 2018, when the patient has recurrent, relapsed, refractory, metastatic, or advanced stage III or IV cancer, hasn't already been tested with the same NGS test for the same cancer genetic content, and has decided to seek further cancer treatment, and when the test has FDA approval or clearance as a companion in vitro diagnostic with an approved indication for that patient's cancer. Miss any of those and the test is nationally non-covered.

Germline testing reads inherited DNA, the genes you were born with, to see whether a cancer runs in the family. Medicare added national coverage for germline NGS as a diagnostic test effective January 27, 2020, but only for patients with ovarian or breast cancer who have a clinical indication for germline testing for hereditary breast or ovarian cancer and a risk factor for it, who haven't already had the same germline NGS test for the same genetic content, and when the test has FDA approval or clearance.

The common thread: both are diagnostic tests for someone who already has cancer, ordered by the doctor treating it.

Where Medicare Coverage Stops

Medicare's national coverage for gene sequencing is narrow on purpose. NCD 90.2 applies only to diagnostic lab tests using NGS for somatic and germline cancer, and it says outright that NGS for a patient with acquired cancer is nationally non-covered when the criteria above aren't met. So these sit outside it:

  • A test no treating physician ordered, including a direct-to-consumer DNA kit you buy on your own.
  • A test for someone with no cancer diagnosis behind it.
  • A repeat of the same NGS test, for the same genetic content, you've already been tested with.

One category is left to the regional level rather than settled nationally: NGS used for RNA sequencing and protein analysis is for your Medicare Administrative Contractor, the company that processes claims in your region, to decide.

Underneath all of it sits the general rule for lab work. According to Medicare.gov, Part B covers medically necessary diagnostic laboratory tests when your health care provider orders them, and Medicare also covers some preventive tests and screenings.

If you've had a genetic test done and paid out of pocket, the order behind it is the first place to look: Part B's laboratory coverage runs through a test your health care provider ordered because it was medically necessary.

What a Covered Genetic Test Costs

So what does a covered genetic test actually run you? When the test qualifies as a diagnostic laboratory test your doctor orders, it's billed through Part B as lab work. If the same visit also involves other services, an office visit or a specialist consult, those follow standard Part B rules: you pay the annual deductible ($283 in 2026) and then 20% of the Medicare-approved amount.

If you have a Medicare Advantage plan instead of Original Medicare, your copays and prior-authorization rules can differ from what's described here, so confirm the details with your plan before the test is run.

How to Get a Genetic Test Covered

Every covered genetic test above runs through the same door: a treating physician has to order it, and it has to be medically necessary for your diagnosis. It comes from the doctor treating you, not from a test you arrange on your own.

A few practical steps:

  1. Talk to the doctor treating the condition, usually an oncologist for cancer NGS testing.
  2. Ask them to confirm the test meets Medicare's coverage rules for your specific situation before it's ordered.
  3. Check that the lab is CLIA-certified, since NCD 90.2 requires the test be performed in a CLIA-certified laboratory.

If you're not sure whether a test meets Medicare's conditions in your case, that's exactly the question to put to your doctor's office before anything gets run.

Frequently Asked Questions

Does Medicare cover genetic testing for cancer?

Yes, in specific situations. Under NCD 90.2, Medicare covers Next-Generation Sequencing as a diagnostic test for people with recurrent, relapsed, refractory, metastatic, or advanced stage III or IV cancer, when a treating physician orders it, it runs in a CLIA-certified lab, and the other conditions are met. If those criteria aren't met, the test is nationally non-covered. The NCD applies only to diagnostic lab tests for cancer, so it's coverage for people who already have a cancer diagnosis.

Does Medicare cover inherited (germline) cancer gene testing?

Yes, but narrowly. Medicare added national coverage for germline NGS testing as a diagnostic test effective January 27, 2020, for patients with ovarian or breast cancer who have a clinical indication for germline testing for hereditary breast or ovarian cancer and a risk factor for it, and who haven't already had the same germline NGS test for the same genetic content. As with the tumor-based test, a treating physician has to order it and it has to run in a CLIA-certified lab. Outside those conditions, NCD 90.2's national coverage doesn't reach it.

Will Medicare pay for a DNA test if I'm healthy and just want to know my risk?

Not under the rules on this page. NCD 90.2's national coverage of NGS applies only to diagnostic lab tests for cancer, ordered by the physician treating it, and Part B's laboratory coverage is for medically necessary diagnostic tests your health care provider orders. A kit you buy yourself, with no diagnosis and no treating physician's order behind it, doesn't fit either description. If a doctor does have a clinical reason to test you, ask the office to confirm coverage before the test is run.

Does a Medicare Advantage plan cover genetic testing?

Medicare Advantage plans cover the services Original Medicare covers, but they set their own copays and often require prior authorization. If you're in an Advantage plan, call the plan and confirm coverage and any approval steps before the test is ordered.

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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