Currentsierra health and lifePolicy 2026T0597P
Preimplantation Genetic Testing and Related Services
Policy defines medical necessity criteria, covered related services, exclusions, and coding clarifications for preimplantation genetic testing (PGT-M and PGT-SR) and associated IVF services for UnitedHealthcare Commercial and Individual Exchange plans. This part covers indications, definitions, coverage rationale, limitations, related service coverage, coding guidance, and clinical evidence summaries.
Policy Summary
Payersierra health and life
PolicyPreimplantation Genetic Testing and Related Services
Policy CodePolicy 2026T0597P
Change TypeTemplate Update; shared policy creation
Effective DateJan 1, 2026
Next Review Date
Key ActionPGT must be ordered by a physician after genetic counseling; document counseling and clinical indication to support medical necessity.
POLICY UPDATE CHANGES
Template Update and creation of shared policy version to support application to Oxford plan membership and archived previous policy versions.
2Covered PGT types (PGT-M, PGT-SR)
1HLA typing covered for sibling treatment
3Explicitly excluded/unproven uses (PGT-A, gender selection, PGT-P)
78.5%Diagnostic efficacy reported (PGT-HLA)