Utah Code 26B-3-134. Coverage of exome sequence testing

(1) As used in this section, “exome sequence testing” means a genomic technique for sequencing the genome of an individual for diagnostic purposes.

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Medicaid program: means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to Title XIX of the federal Social Security Act. See Utah Code 26B-3-101

(2) The Medicaid program shall reimburse for exome sequence testing:

(2)(a) for an enrollee who:

(2)(a)(i) is younger than 21 years old; and

(2)(a)(ii) who remains undiagnosed after exhausting all other appropriate diagnostic-related tests;

(2)(b) performed by a nationally recognized provider with significant experience in exome sequence testing;

(2)(c) that is medically necessary; and

(2)(d) at a rate set by the Medicaid program.