Understanding Your Medicare Preventive Genetic Benefits
Under federal CMS guidelines, traditional Medicare Part B covers 100% of allowable costs for physician-ordered genetic testing when medical necessity is established—meaning $0 out-of-pocket copay or deductible for qualifying seniors.
1. Zero Out-of-Pocket Cost
When criteria are met, testing is billed directly to Medicare Part B. You will never receive a bill for covered services.
2. Physician Ordered & Reviewed
CMS mandates that all diagnostic genetic tests must be ordered by a licensed physician who confirms personal or family medical necessity.
3. No-Surprise-Billing Guarantee
If your Medicare plan or medical profile does not qualify, no swab kit is sent and zero charges are ever billed to you.
When Does Medicare Part B Deem Testing Medically Appropriate?
Hereditary Cancer Screening (CGx)
Covered when an individual has a personal history of cancer or a significant multi-generational family history of breast, ovarian, colorectal, or prostate cancer meeting NCCN guideline thresholds.
Pharmacogenomics (PGx)
Covered for seniors taking multiple daily medications (polypharmacy), starting critical therapies (such as blood thinners or cardiac drugs), or experiencing adverse medication side effects.