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T are submitted without all of the required information will be returned for correction. Fax the completed form to 1-512-302-5039 or call 1-888-302-6167 for authorization. Client Information First Name: Last Name: DOB: Middle Initial: Client Medicaid Number: Requesting Provider Information Name: Address: City: State: TPI: Zip: NPI: Taxonomy: Telephone number: Fax number: Performing/Facility Provider Information (if different from requesting provider) Name: Address: City: State:.

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82677, 86336); is an optional noninvasive evaluation that combines an ultrasound, maternal blood screening at 12 weeks, and additional bloodwork at 16 weeks in evaluation of the fetus to identify risk for specific chromosomal abnormalities: Down Syndrome (Trisomy21) and Edwards Syndrome (Trisomy 18).

United Healthcare NIPT is considered medically necessary in the following circumstances: Maternal age or oocyte age of 35 years or older at delivery; or. Fetal ultrasound findings indicating an increased risk of aneuploidy; or.

NIPT is not rebated by Medicare and is not covered by private health insurance.

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.

Therefore, Next Generation Sequencing Panel tests are considered not medically necessary for BlueCHiP for Medicare and are not covered for Commercial Products. Exception: Testing represented by CPT code 81420 is a covered service for BlueCHiP for Medicare and Commercial Products.

The Current Procedural Terminology (CPT®) code 81420 as maintained by American Medical Association, is a medical procedural code under the range - Genomic Sequencing Procedures and Other Molecular Multianalyte Assays.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232