CONCERT GENETIC TESTING: Prenatal and Preconception Carrier Screening
Criteria for when prenatal and preconception carrier genetic tests (expanded and basic panels and specific gene analyses) are considered medically necessary for members/enrollees considering pregnancy or currently pregnant, for Ambetter Nevada (Centene-affiliated health plans).
Updated CFTR sequencing criteria to change number of tested variants from 23 to 100 consistent with 2023 ACMG statement.
Added CPT code 81361 to the Policy Reference Table and criteria set to reflect inclusion of hemoglobinopathy tests on panel.
Clarified that HBA1/HBA2/HBB sequencing criteria aligned with ACOG universal hemoglobinopathy screening and moved some general targeted carrier screening criteria to a separate 'General Approach' policy.
FMR1 repeat analysis criteria updated to distinguish carrier screening from diagnostic testing and to clarify billing note when 81243 is billed with 81443.
Multiple CPT/code removals and replacements across expanded carrier panel examples and reference table (e.g., removals of 81329, 81403, additions of 81479 etc.).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.