CurrentMolina HealthcarePolicy N/A

Noninvasive Prenatal Testing (NIPT) Reimbursement

Defines Molina Healthcare's reimbursement policy for noninvasive prenatal testing (NIPT)/noninvasive prenatal screening (NIPS) for fetal aneuploidy and who is eligible for coverage.

Policy Summary

PayerMolina Healthcare

PolicyNoninvasive Prenatal Testing (NIPT) Reimbursement

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionOrder NIPT once per pregnancy when the member meets clinical criteria such as maternal age ≥35, ultrasound risk, prior trisomy, positive aneuploidy screen, or parental Robertsonian translocation.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

once per pregnancyNIPT covered frequency

4 listedcovered codes

3 listednot billable codes

age ≥35maternal age criterion

11/20/2020–07/31/2025documentation history

Coverage Criteria for NIPT

Coverage criteria for NIPT

NIPT for fetal aneuploidy is covered for singleton pregnancies when any of the following clinical criteria are met:

ANY of the following

Maternal age 35 years or older at the time of delivery
Fetal ultrasound results indicate an increased risk of aneuploidy
History of a previous pregnancy with a trisomy
Positive results from an aneuploidy test (first trimester, sequential, integrated, or quadruple screen)

Policy Summary

PayerMolina Healthcare

PolicyNoninvasive Prenatal Testing (NIPT) Reimbursement

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

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 Coding for NIPT

Covered codes for NIPTCPT | HCPCSCovered

81407	Molecular pathology procedure, Level 8
81420	Fetal chromosomal aneuploidy genomic sequence analysis panel, maternal blood
81507	Fetal aneuploidy DNA sequence analysis using maternal plasma
0009M	Fetal aneuploidy DNA sequence analysis using maternal plasma

Not billable for NIPTCPT | HCPCSNot Covered

81479	Unlisted molecular pathology procedure
81599	Unlisted multianalyte assay with algorithmic analysis
88271	Chromosomal Microarray (FISH), Constitutional

Frequency limit

Frequency limitNIPT for fetal aneuploidy is covered once per pregnancy.

ScopeApplies when clinical coverage criteria for singleton pregnancies are met (see coverage criteria).

Billing implicationOnly one NIPT claim per pregnancy should be submitted under covered codes 81407, 81420, 81507, or 0009M.

Prior Authorization and Billing Guidance

Billing Rule

Prior authorization and billing: bill only covered NIPT codes; one test per pregnancy

NIPT for fetal aneuploidy is covered once per pregnancy when the member has a singleton pregnancy and meets any listed clinical criteria. Bill only the specific covered procedure codes (81407, 81420, 81507, 0009M); do not bill unlisted or unrelated procedure codes (81479, 81599, 88271).

Coverage is limited to one NIPT per pregnancy when clinically appropriate.
Only submit claims for covered codes: 81407, 81420, 81507, 0009M.
Do not bill the following codes for NIPT: 81479, 81599, 88271.

OpenPayer

Noninvasive Prenatal Testing (NIPT) Reimbursement

Coverage Criteria for NIPT

Billing and Coding for NIPT

Prior Authorization and Billing Guidance

Definitions