CurrentAmbetter NevadaPolicy N/A

Concert Genetic Testing: Preimplantation Genetic Testing

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This policy governs genetic testing of biopsied embryo cells performed with in vitro fertilization, including testing for aneuploidy, monogenic disorders, and structural chromosomal rearrangements. It applies to providers seeking coverage for these services under Ambetter Nevada.

Policy Summary

PayerAmbetter Nevada

PolicyConcert Genetic Testing: Preimplantation Genetic Testing

Policy CodePolicy N/A

Change TypeNo material clinical or coverage change

Effective Date05/01/2026

Last ReviewNov 1, 2025

Next Review DateN/A

Key ActionApply this clinical policy together with all applicable coverage documents, exclusions, limitations, and state and federal requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Preimplantation genetic testing types addressed

3Parent-risk scenarios supporting PGT-M

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CurrentAmbetter NevadaPolicy N/A

Concert Genetic Testing: Preimplantation Genetic Testing

Customize your policy alerts

Sign up for all Ambetter Nevada policy alerts

Know when Ambetter Nevada releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerAmbetter Nevada

PolicyConcert Genetic Testing: Preimplantation Genetic Testing

Policy CodePolicy N/A

Change TypeNo material clinical or coverage change

Effective Date05/01/2026

Last ReviewNov 1, 2025

Next Review DateN/A

Key ActionApply this clinical policy together with all applicable coverage documents, exclusions, limitations, and state and federal requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Preimplantation genetic testing types addressed

3Parent-risk scenarios supporting PGT-M

1PGT-SR medically necessary indications

PGT-ATesting type not supported for all indications

2Coverage precedence notices

Coverage Criteria

Preimplantation Genetic Testing for Aneuploidy (PGT-A)

Current evidence does not support coverage of PGT-A for all indications.

Evidence limitation: Current evidence does not support preimplantation genetic testing for aneuploidy (PGT-A) for all indications.

Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)

PGT-M may be considered medically necessary when the embryo is at elevated risk of a genetic disorder and at least one of the following parental-risk conditions applies.

PGT-M medical necessity

At least one parental-risk condition
- Autosomal recessive risk: Both biological parents are known carriers for the same autosomal recessive disorder.
- Autosomal dominant risk: One biological parent is a known carrier of an autosomal dominant disorder.
- X-linked recessive risk: One biological parent is a known carrier of an X-linked recessive disorder.

Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)

PGT-SR may be considered medically necessary when the embryo is at elevated risk of a genetic disorder because one biological parent has a chromosomal rearrangement.

PGT-SR medical necessity: The embryo is at an elevated risk of a genetic disorder because one biological parent has a chromosomal rearrangement.

PGT-A for all indications is not supported by current evidence.

PGT-M for indications outside the specified elevated-risk parental carrier scenarios is not supported by current evidence. The specified scenarios are when both biological parents are known carriers of the same autosomal recessive disorder, one biological parent is a known carrier of an autosomal dominant disorder, or one biological parent is a known carrier of an X-linked recessive disorder.

PGT-SR for indications outside elevated embryo risk due to a chromosomal rearrangement in one biological parent is not supported by current evidence.

Coding

Preimplantation Genetic Testing for Aneuploidy (PGT-A)mixed

81229	CPT code referenced for Preimplantation Genetic Testing for Aneuploidy (PGT-A)
81479	CPT code referenced for Preimplantation Genetic Testing for Aneuploidy (PGT-A)
89290	CPT code referenced for Preimplantation Genetic Testing for Aneuploidy (PGT-A)
89291	CPT code referenced for Preimplantation Genetic Testing for Aneuploidy (PGT-A)
0254U	CPT code referenced for Preimplantation Genetic Testing for Aneuploidy (PGT-A)
N97.0	ICD-10 code referenced for Preimplantation Genetic Testing for Aneuploidy (PGT-A)
N97.9	ICD-10 code referenced for Preimplantation Genetic Testing for Aneuploidy (PGT-A)
Z31	ICD-10 code referenced for Preimplantation Genetic Testing for Aneuploidy (PGT-A)

Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)mixed

81479	CPT code referenced for Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
89290	CPT code referenced for Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
89291	CPT code referenced for Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
0396U	CPT code referenced for Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
N97.0	ICD-10 code referenced for Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
N97.9	ICD-10 code referenced for Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
Z14.8	ICD-10 code referenced for Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
Z31	ICD-10 code referenced for Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)

Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)mixed

81228	CPT code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)
81229	CPT code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)
81479	CPT code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)
89290	CPT code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)
89291	CPT code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)
N97.0	ICD-10 code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)
N97.9	ICD-10 code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)
Z14.8	ICD-10 code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)
Z31	ICD-10 code referenced for Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)

Provider Actions

Note

Apply Policy With Governing Coverage Documents

Use this clinical policy as a guide to medical-necessity and coverage decisions, not as a contract or guarantee of payment or results. Apply all applicable terms, conditions, exclusions, and limitations in the member’s coverage documents, together with state and federal requirements and Health Plan administrative policies and procedures; where a legal or regulatory requirement conflicts with the policy effective date, law and regulation govern.

Review the applicable evidence of coverage, certificate of coverage, policy, insurance contract, and related coverage documents.
The Health Plan may change, amend, or withdraw this policy, and the posting date may differ from the policy effective date.

Documentation Required

Review Medicare and Medicaid Requirements

Before applying these criteria, providers must review applicable Medicare and Medicaid coverage requirements and any controlling precedence notices.

For Medicaid members, state Medicaid coverage provisions take precedence when they conflict with this policy; refer to the applicable state Medicaid manual.

Background

Preimplantation genetic testing analyzes cells biopsied from an embryo during an assisted reproductive procedure, generally in conjunction with in vitro fertilization (IVF). The testing may evaluate chromosomal aneuploidy, specific single-gene disorders, or structural chromosomal rearrangements.

Definitions

Preimplantation Genetic Testing for Aneuploidy (PGT-A)

PurposeScreens for chromosomal aneuploidy.

IVF contextUsed in conjunction with in vitro fertilization (IVF) for couples.

Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)

PurposeDetects a specific single-gene inherited disorder or chromosome rearrangement.

IVF contextUsed in conjunction with in vitro fertilization (IVF).

Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR)

Covered Indications

PGT-M: Both Biological Parents Carry the Same Autosomal Recessive Disorder

PGT-M may be considered medically necessary when the following condition is met:

Covered indication: The embryo is at an elevated risk of a genetic disorder, and both biological parents are known carriers for the same autosomal recessive disorder.

PGT-M: One Biological Parent Carries an Autosomal Dominant Disorder

PGT-M may be considered medically necessary when the following condition is met:

Covered indication: The embryo is at an elevated risk of a genetic disorder, and one biological parent is a known carrier of an autosomal dominant disorder.

PGT-M: One Biological Parent Carries an X-Linked Recessive Disorder

PGT-M may be considered medically necessary when the following condition is met:

Not Covered

The following services are not covered under this policy: PGT-A for all indications; PGT-M for indications other than the specified elevated-risk parental carrier scenarios; and PGT-SR for indications other than elevated embryo risk caused by a chromosomal rearrangement in one biological parent.

Policy Summary

PayerAmbetter Nevada

PolicyConcert Genetic Testing: Preimplantation Genetic Testing

Policy CodePolicy N/A

Change TypeNo material clinical or coverage change

Effective Date05/01/2026

Last ReviewNov 1, 2025

Next Review DateN/A

Key ActionApply this clinical policy together with all applicable coverage documents, exclusions, limitations, and state and federal requirements.

SourceLink

On This Page

For Medicare members, review all applicable Medicare National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Medicare Coverage Articles before applying this policy; consult CMS for additional information.

Denial Risk

PGT-A: Not Supported for All Indications

Current evidence does not support preimplantation genetic testing for aneuploidy (PGT-A) for all indications.

Do not assume PGT-A is supported solely because a patient is undergoing IVF; assess the indication against applicable coverage requirements.

Denial Risk

PGT-M: Indication Must Meet Parental Carrier Criteria

PGT-M may be considered medically necessary only when the embryo is at elevated risk of a genetic disorder because of specified parental carrier scenarios. Current evidence does not support PGT-M for all other indications.

Both biological parents are known carriers for the same autosomal recessive disorder.
One biological parent is a known carrier of an autosomal dominant disorder.
One biological parent is a known carrier of an X-linked recessive disorder.

Denial Risk

PGT-SR: Indication Must Meet Structural-Rearrangement Criteria

PGT-SR may be considered medically necessary only when the embryo is at elevated risk of a genetic disorder because one biological parent has a chromosomal rearrangement. Current evidence does not support PGT-SR for all other indications.

Confirm that the elevated embryo risk is attributable to a chromosomal rearrangement in one biological parent.
Indications outside this parental chromosomal-rearrangement scenario are not supported by current evidence.

Note

Encourage Genetic Counseling

Encourage patients who are considering or undergoing IVF and preimplantation genetic testing to obtain genetic counseling before testing and as clinically appropriate during care. Counseling should be provided by an appropriately qualified genetics professional who can review the indication, potential benefits and limitations, alternatives, and implications of testing.

Document the recommendation for genetic counseling and the patient’s counseling status when relevant to the requested service.
Coordinate counseling with the treating and reproductive-care team so testing decisions reflect the patient’s clinical circumstances and informed preferences.

Detects a specific single-gene inherited disorder or chromosome rearrangement.

IVF contextUsed in conjunction with in vitro fertilization (IVF).

Covered indication: The embryo is at an elevated risk of a genetic disorder, and one biological parent is a known carrier of an X-linked recessive disorder.

PGT-SR: Parental Chromosomal Rearrangement

PGT-SR may be considered medically necessary when the following condition is met:

Covered indication: The embryo is at an elevated risk of a genetic disorder because one biological parent has a chromosomal rearrangement.