Coverage for Noninvasive Prenatal Testing (NIPT)
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This alert announces that MedStar Family Choice District of Columbia (MFC-DC) and the District's Department of Health Care Finance (DHCF) now cover and reimburse noninvasive prenatal testing (NIPT) for pregnant women; it applies to providers submitting claims to MFC-DC. Specified NIPT CPT codes do not require prior authorization.
Effective March 1, 2022, DHCF has added coverage and reimbursement for Noninvasive Prenatal Testing (NIPT).
Coverage Criteria for NIPT
Coverage for NIPT
Covered when billed using the listed CPT codes
The alert does not list any specific exclusions. There are no explicit exclusion conditions identified for Noninvasive Prenatal Testing (NIPT) in this notice; coverage is described only in terms of billing with the listed CPT codes and the effective date of coverage.
This document does not specify any clinical or situational conditions under which NIPT would be considered not medically necessary. The notice states coverage and reimbursement for NIPT and notes that the listed CPT codes do not require prior authorization, without defining circumstances that would render the service noncovered or not medically necessary.
Coding — CPT Codes
| 81329 | SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; dosage/deletion analysis; includes SMN2 analysis, if performed. |
| 81336 | SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; full gene sequence. |
| 81337 | SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; known familial sequence variant(s). |
| 81420 | Fetal chromosomal aneuploidy genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood; must include analysis of chromosomes 13, 18 and 21. |
| 81422 | Fetal chromosomal microdeletion(s) genomic sequence analysis, circulating cell-free fetal DNA in maternal blood. |
| 81479 | Unlisted molecular pathology procedure. |
| 81507 | Fetal aneuploidy DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy. |
Provider Actions and Billing Guidance
Prior authorization not required for listed NIPT CPT codes
Effective March 1, 2022, the listed NIPT CPT codes (81329, 81336, 81337, 81420, 81422, 81479, 81507) are covered and do not require prior authorization.
- Apply these CPT codes when billing for NIPT services to ensure coverage.
Provider impact: Coverage and billing highlight
This alert notifies providers that NIPT is covered per DHCF and that the specified codes are reimbursable; ensure claims use one of the listed CPT codes. The document provides no additional clinical restrictions or step-therapy requirements.
- Coverage applies when billed using one of the listed CPT codes.
- No clinical eligibility criteria or step-therapy are specified in this alert.
Provider contact for questions
For questions about this Provider Alert, contact MFC-DC Provider Relations Monday–Friday, 8:00 a.m. to 5:30 p.m. for inquiries and claim support.
- Phone: 855-798-4244, Option 2
- Email: mfcdc-providerrelations@medstar.net
Prior authorization not required — cannot be basis for denial
Absence of prior authorization for the listed NIPT CPT codes cannot be used as a basis to deny a claim; the NIPT codes do not require prior authorization.
- Do not reject or deny claims solely because a prior authorization is not present for these CPT codes.
Background
Noninvasive Prenatal Testing (NIPT) analyzes circulating cell-free fetal DNA in maternal blood to screen for fetal chromosomal aneuploidies (for example, trisomy 21, 18 and 13) and certain microdeletions. The alert references professional guidance (ACOG) as the clinical justification for coverage and indicates that, effective March 1, 2022, DHCF added coverage and reimbursement for NIPT when billed with the listed CPT codes.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.