Prior authorization requirements for non-invasive prenatal testing

Reason for the change

This change is part of our comprehensive effort to simplify the health care experience for our members and network health care professionals. While we’ll no longer require prior authorizations for these services, reimbursement is dependent on appropriate and medically-necessary use of the test, as defined by the medical policy.

Affected procedures

This change applies to the following procedures:

• 0327U: Fetal aneuploidy (trisomy 13, 18 and 21), DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy, includes sex reporting, if performed
• 81420: Fetal chromosomal aneuploidy (e.g., trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18 and 21
• 81507: Fetal aneuploidy (trisomy 21, 18 and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy

Affected plans

This change affects the following plans:

• UnitedHealthcare Insurance Company
• UnitedHealthcare of the Mid-Atlantic, Inc.
• UnitedHealthcare Plan of the River Valley, Inc. and UnitedHealthcare Insurance Company of the River Valley
• Oxford Health Insurance, Inc.
• UnitedHealthcare Level Funded (formerly All Savers Insurance Company and All Savers Life Insurance Company of California)
• Neighborhood Health Partnership, Inc.
• UnitedHealthcare Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans, including Rocky Mountain Health Plans also referred to as Off-Exchange plans including Monument Health HMO, Monument ONE, Rocky Mountain Sky Plans and Rocky Mountain Valley Plans 
• UnitedHealthcare Community Plans