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  • Husky Health Programprovidersprenatal Testing For Fetal Aneuploidy Prior Authorization Request Form

Get Husky Health Programprovidersprenatal Testing For Fetal Aneuploidy Prior Authorization Request Form

HUSKY Health Program Noninvasive Prenatal Testing for Fetal Aneuploidy Prior Authorization Request Form This form MUST be completed and signed by the ORDERING PROVIDERThe LABORATORY must then fax the form to 203.265.3994Phone: 1.800.440.5071Member InformationMember ID #:DOB:Member Name (Last, First):Address:City, State, Zip:Requested TestingCPT Code:Date of Service:Diagnosis (ICD10 CM) Code(s):EDC:The patient has a singleton pregnancy determined to be at increased risk of fetal aneuploidy (triso.

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Most insurance plans cover prenatal testing, especially for women over 35 years of age. You may need a referral from your primary care physician or health plan for your health insurance to cover the services.

NIPT is now widely covered for high-risk pregnant women, according to the Coalition for Access to Prenatal Screening. Plus, 40 commercial insurers cover NIPT for all pregnant women, including Cigna Corp., Geisinger Health Plan, Anthem, Inc. and slew of regional Blue Cross Blue Shield plans.

Sequencing-based non-invasive prenatal testing (NIPT) (CPT® codes 81420, 81507) to screen for fetal trisomy 13, 18 and 21 is considered medically necessary in a viable, single gestation pregnancy 10 weeks gestation.

Cystic fibrosis (CF) carrier screening with a targeted test for common variants (CPT code 81220) is medically necessary when testing has not been previously performed. Spinal muscular atrophy (SMA) carrier screening by SMN1 gene dosage analysis is medically necessary when testing has not been previously performed.

NIPT is considered noninvasive because it requires drawing blood only from the pregnant woman and does not pose any risk to the fetus. NIPT is a screening test, which means that it will not give a definitive answer about whether or not a fetus has a genetic condition.

CPT®81420, Under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays. 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.

ACOG suggests that NIPT be offered to all pregnant women. However, they only recommend NIPT for high risk women.

In addition, a negative result does not guarantee that a fetus harbors no chromosomal abnormality, and NIPT does not test for all chromosomal disorders. Aside from its ability to detect disorders, it can also predict fetal sex some 10 weeks earlier than the standard ultrasound and with a 99 percent accuracy.

HUSKY Health primarily uses InterQual® Molecular Diagnostics Criteria when reviewing prior authorization requests for coverage of most genetic tests. HUSKY Health will use this policy to review requests for genetic tests for which InterQual® Molecular Diagnostics Criteria are not available.

Tier 2 CPT codes, which range from CPT 81400 through 81408, are general genetic testing procedures arranged in order of increasing complexity, with 81400 being the least complex and time-consuming (so-called Level 1) and 81408 being the most complex (Level 9).

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© Copyright 1997-2025
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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