Cell-Free Fetal DNA Testing (for New Mexico Only)
UnitedHealthcare New Mexico medical policy on use of maternal plasma cell-free fetal DNA (cfDNA) testing for fetal genotyping and aneuploidy screening, defining medically necessary indications (notably RhD/alloimmunization) and listing technologies/tests considered unproven/unnecessary.
Added language that cfDNA testing using maternal plasma to determine fetal genotype is proven and medically necessary when the individual is alloimmunized or at risk for alloimmunization due to maternal RhD status or red cell antigen antibodies and all listed conditions are met.
Removed prior language indicating DNA-based noninvasive prenatal tests of fetal aneuploidy are proven and medically necessary as screening tools for trisomies 21, 18, 13 (with/without sex chromosomes) for listed higher-risk circumstances (e.g., maternal age ≥35, abnormal ultrasound, prior affected pregnancy, positive prior screening, parental translocation, screening after counseling).
Replaced broad 'unproven and not medically necessary for all other indications' language with a clarified statement that cfDNA testing using maternal plasma is unproven and not medically necessary for indications beyond screening for trisomies 21, 18, 13, and sex chromosome aneuploidy, and revised the list of unproven indications.
Vanadis® was removed from the policy as unproven and not medically necessary.
Removed CPT codes 0327U, 81420, and 81507 from applicable codes.
Removed a long list of ICD-10 diagnosis codes from applicable codes.
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