Genetic tests are helping to alter health care by connecting people with more tailored diagnoses and treatments as they become more widely available. However, deciding whether or not to pay for them can be difficult for health plans.
One prime example is obstetrics, where cell-free DNA-based noninvasive prenatal testing (NIPT) is gaining popularity among patients and professionals alike, yet payers range in their coverage of it.
The fact that NIPT is a simple blood test that allows expectant parents to learn their baby’s sex in the first trimester contributes to its popularity. However, the primary goal of the test is to examine maternal and fetal DNA fragments for Down syndrome and other chromosomal abnormalities. It is more accurate in screening for Down syndrome than an older, “conventional” technique of screening, which combines a blood test known as serum screening with a prenatal ultrasound, according to supporters and study.
According to the Coalition for Access to Prenatal Screening, NIPT is now commonly covered for “high-risk” pregnant women. In addition, 40 commercial insurers, including Cigna Corp., Geisinger Health Plan, Anthem, Inc., and a bevy of regional Blue Cross Blue Shield plans, cover NIPT for all pregnant women. However, several state Medicaid programs, as well as two of the country’s major private insurers, Aetna Inc. and UnitedHealthcare, are still opposed to paying for the test for all pregnant women.
“Insurance coverage has not caught up to the demand” for NIPT, according to Blair Stevens, a prenatal expert for the National Society of Genetic Counselors. She speculates that one explanation is because the newest screening technology is more expensive than its predecessor. Furthermore, while “it is obvious that NIPT is a better test for Down syndrome,” she says, “there is contradictory data on whether it is a better screen for more rare disorders.”
One major issue with genetic testing of all kinds is that there is no single organization to analyze them, such as the FDA, according to Lon Castle, M.D., chief of molecular diagnostics and specialty drug management at eviCore healthcare. “What we’re left with now is health plans and government organizations doing their best to keep up with these things as they come out, reviewing the data and making recommendations,” he says.
Does Aetna cover Natera NIPT?
NEW YORK (AP) Aetna’s coverage policy was amended this week to include noninvasive prenatal testing (NIPT) for all pregnancies.
The Hartford, Connecticut-based insurer now considers NIPT employing cell-free fetal nucleic acids in maternal blood to be medically required for screening for fetal aneuploidy in all pregnant women, according to Aetna’s new policy.
The decision comes as a number of insurance companies, including UnitedHealthcare and Humana, have begun to cover NIPT for low-risk pregnancies. The American College of Obstetricians and Gynecologists (ACOG) released new guidelines this summer that urge prenatal aneuploidy screening for all pregnant women, regardless of age or other risk factors.
Several companies provide NIPT for low-risk pregnancies, but Natera is largely seen as the biggest winner, as more payors now cover that market.
According to Natera of San Carlos, California, which supplies the Panorama SNP-based prenatal blood test for the early diagnosis of genetic diseases, over 90% of all commercially covered lives in the United States now have average-risk NIPT coverage.
“With the approvals made this week, NIPT is now covered by all 20 of the top commercial payors, regardless of prior risk,” said Ramesh Hariharan, general manager of Natera’s women’s health business. “With our one-of-a-kind SNP-based NIPT, we’ll have an even better chance of improving prenatal care.”
What is the CPT code for NIPT?
In a viable single or twin gestation pregnancy of less than 10 weeks, sequencing-based non-invasive prenatal testing (NIPT) (CPT codes 81420, 81507) to screen for fetal trisomy 13, 18, and 21 is considered medically required.
Does insurance Cover Down syndrome testing?
The concern of abnormalities in early pregnancy is frequent among expectant parents. Here are some ideas for how you can find out whether you have them.
1) Multi-Screen:
This is a blood test that takes about 15-20 weeks to complete. Down’s syndrome and Spina Bifida, two common birth abnormalities, are detected by the test. In most cases, insurance will pay the cost of the test. Two weeks following the blood draw, the results are usually available.
2) Ultrasound Level II:
This test uses an ultrasound on your tummy to obtain photos of your baby. At 18-22 weeks, a specialist performs the procedure. An ultrasound can be used to check for anatomical issues in the baby, such as if the heart and brain are developing appropriately. It is not capable of detecting all birth abnormalities. This test may be covered by insurance; if not, it normally costs around $150.
3) Screening in the First Trimester:
This test combines an ultrasound of the baby’s neck (nuchal translucency) with a blood test to look for Down’s Syndrome and other chromosomal abnormalities such as Trisomy 18 (it’s done at 12 weeks). It detects 90 percent of Down’s Syndrome patients. A perinatologist performs this test. Because it isn’t currently recognized standard of care, it may not be covered by insurance. It will set you back around $500.
Other testing is available since hereditary birth abnormalities are more likely in women over 35. The triple screen, ultrasound, or first trimester screening may be given to women, but slightly more intrusive tests may be needed as well. This comprises one of the two tests listed below.
A doctor uses a needle to extract fluid from around the baby during this procedure. The fluid is transferred to a laboratory, where the baby’s genetic material is examined. This test detects Down’s Syndrome with a 99 percent accuracy rate. It has a 0.4 percent chance of miscarriage. The test takes 16-20 weeks to complete, and the findings are available in 2 weeks.
To remove cells from the baby’s placenta, a specialist inserts a catheter into the vaginal canal and cervix, or into the abdomen. The tissue is transported to a laboratory for analysis. This test reveals Down’s Syndrome in 99 percent of infants. It has a 0.8 percent chance of miscarriage. The test takes 10-13 weeks to complete, and the results are accessible in 3 days.
Is prenatal genetic testing covered by insurance?
While genetic testing for pregnancy can cost anywhere from $100 to $1,000, most tests are covered by insurance. If a pregnancy is at high risk for a genetic or chromosome disease, insurance is more likely to pay testing, but many options are covered in low risk pregnancies as well. Newer genetic testing, such as whole exome sequencing, will be more expensive than tests that have been around for a long time, such as serum screening. It can be difficult to understand the expenses of genetic testing, but most genetic testing facilities will check your insurance coverage on your behalf.
Self-pay solutions are frequently available if insurance does not cover a test. Some laboratories even offer financial assistance to minimize or even eliminate the costs of genetic testing during pregnancy.
Below is further information about the cost of pregnancy genetic testing. Visit pregnancy genetic testing to learn more about the tests described on this page.
How accurate is NIPT testing for gender?
NIPTs offer a safer alternative to more intrusive genetic testing for detecting chromosomal disorders earlier in pregnancy. They’re usually pretty accurate (though not 100 percent).
There are also tests that you can perform at home. However, we recommend going through your doctor to ensure that your sample is properly processed.
If you can’t wait to find out your baby’s gender and don’t need their genetic information just yet, you can take a fun at-home DNA test.
Is it worth getting NIPT test?
You’re probably in the first trimester of pregnancy if you’re seeking for information on noninvasive prenatal testing (NIPT). First and foremost, congratulations! Take a deep breath and acknowledge how far you’ve already progressed.
While this time is full with joy and excitement, we understand that discussions about genetic testing with your OB-GYN or midwife might cause anxiety. It suddenly becomes a reality for every mama bear who must decide whether or not to screen for anything that could harm her developing cub.
We recognize that making these choices on your path to parenting can be difficult. However, being well-informed is one way to feel more confident. We’ll walk you through the NIPT screening test, including what it is and what it can (and can’t) tell you, so you can make the best decision for you.