CurrentFidelis CarePolicy FC.PP.033

Spinal Muscular Atrophy (SMA) Carrier Screening in Pregnancy

This payment policy governs coverage and reimbursement for spinal muscular atrophy (SMA) carrier screening (CPT 81329, 81336) for members of Fidelis Care products, specifying when testing is covered and when it is not.

Policy Summary

PayerFidelis Care

PolicySpinal Muscular Atrophy (SMA) Carrier Screening in Pregnancy

Policy CodePolicy FC.PP.033

Change TypeNo material changes

Effective Date

Next Review DateMay 30, 2022

Key ActionAuthorization does not guarantee reimbursement; submit claims and confirm member eligibility at time of service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1test per lifetime for pregnant women

81329, 81336CPT codes referenced

AllProduct Types

Not coverednonpregnant women and males

5/30/2022policy last reviewed

Coverage Criteria for SMA Carrier Screening

SMA Carrier Screening Coverage Criteria

Covered when ALL of the following are met:

SMA carrier screening is covered for women who are pregnant.

Only one SMA carrier screening test (CPT 81329 or 81336) is covered per lifetime for pregnant women.

Testing is not covered for nonpregnant women or for males.

Noncoverage for nonpregnant women and males per policy statement.

Coding and Frequency

SMA carrier screening CPT codesCPTCovered

81329	SMN1 deletion analysis; carrier testing (includes SMN2 analysis if performed)
81336	SMN1 gene full gene sequence analysis

Policy Summary

PayerFidelis Care

PolicySpinal Muscular Atrophy (SMA) Carrier Screening in Pregnancy

Policy CodePolicy FC.PP.033

Change TypeNo material changes

Effective Date

Next Review DateMay 30, 2022

Key ActionAuthorization does not guarantee reimbursement; submit claims and confirm member eligibility at time of service.

SourceLink

On This Page

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.

Billing and Prior Authorization Notes

Billing Rule

Prior authorization does not guarantee payment; submit claims and confirm eligibility

Authorization (if obtained) does not guarantee reimbursement. Providers must submit a claim for services rendered and reconfirm member eligibility at the time the service is performed; inclusion or exclusion of codes in this policy does not guarantee coverage and providers should reference current coding manuals when submitting claims.

Authorization does not guarantee reimbursement; submit a claim for services rendered.
Reconfirm member eligibility at time of service.
Inclusion or exclusion of codes in this policy does not guarantee coverage; use current coding guidance when billing.

Definitions

Health Plan

DefinitionHealth Plan means a health plan that has adopted this payment policy and that is operated or administered, in whole or in part, by Centene Management Company, LLC, or any other of such health plan's affiliates, as applicable.

ScopeApplies to plans that have adopted this payment policy; coverage and payment determinations are subject to plan documents and applicable law.

Not a guaranteeThis payment policy does not constitute a contract or guarantee regarding payment or results; plan terms control.

SMA carrier screening (CPT 81329, 81336)

Description (81329)SMN1 deletion analysis; carrier testing (includes SMN2 analysis if performed).

Description (81336)SMN1 gene full gene sequence analysis.

Coverage stanceSMA carrier screening (CPT 81329 and 81336) is covered one test per lifetime for women who are pregnant; not covered for nonpregnant women or males.