V1.2025 Concert Genetic Testing: Preimplantation Genetic Testing (PDF)
Defines medical necessity and investigational determinations for preimplantation genetic testing used with in vitro fertilization, including PGT-A (aneuploidy), PGT-M (monogenic disorders), and PGT-SR (structural rearrangements), with example CPT/PLA codes and associated indications.
Updated title to reflect V1.2025; updated example test in Policy Reference Table and fixed PLA code in criteria.
Coverage Summary
Defines medical necessity and investigational determinations for preimplantation genetic testing used with in vitro fertilization, including PGT-A (aneuploidy), PGT-M (monogenic disorders), and PGT-SR (structural rearrangements), with example CPT/PLA codes and associated indications. PGT-M and PGT-SR may be considered medically necessary in specified situations described in the criteria, while PGT-A is considered investigational per this policy.
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