The largest national private health plans are shown in the table below. Many private payers, as previously mentioned, need prior authorization for medically essential coverage. Visit the Coalition for Access to Prenatal Screening’s website for a more comprehensive list of plans, including Medicaid.
United Healthcare1
- Robertsonian translocation with a higher risk of fetal trisomy 13 or trisomy 21 in the parents; or
- Screening using Shared Decision-Making after pre-test counseling from a board-certified genetic counselor or a prenatal care physician or healthcare professional (SDM)
Medical office notes documenting maternal age, prior pregnancy with a trisomy (if applicable), history of parental balanced Robertsonian translocation, abnormal first- or second-trimester screening test result, counseling provided by genetic counselor or prenatal provider on the risks and benefits of testing using shared decision making are all required by UnitedHealthCare.
Cigna2,3
“Sequencing-based non-invasive prenatal testing (NIPT) (CPT codes 81420, 81507) to screen for fetal trisomy 13, 18, and 21 is considered medically required in a viable, single gestation pregnancy 10 weeks gestation,” according to Cigna’s medical policy document. There is no evidence that there are any limitations based on maternal age, chromosomal abnormality risk, or the use of genetic counseling.
Aetna4
“Aetna considers noninvasive prenatal testing (NIPT) using measurement of cell-free fetal nucleic acids in maternal blood (e.g., MaterniT21, MaterniT21 PLUS, Verifi Prenatal Test, Harmony Prenatal Test, Panorama Prenatal Test, QNatal Advanced) medically necessary for screening for fetal aneuploidy (trisomy 13, 18, and 21) in all pregnant women,” according to the company’s medical policy document For pregnant women who have previously received a multiple serum marker screening test with or without fetal nuchal translucency ultrasound that was negative for fetal aneuploidy during the current pregnancy, Aetna believes NIPT is not medically necessary.” There is no evidence that there are any limitations based on maternal age, chromosomal abnormality risk, or the use of genetic counseling.
Molina Healthcare5
When all of the following conditions are met, non-invasive prenatal testing (NIPT) employing maternal cell-free DNA (cfDNA) screening for fetal aneuploidy (trisomy 13, 18, and 21) may be declared medically essential and authorized:
- A balanced Robertsonian translocation in either parent has been reported, with an increased risk of fetal trisomy 13 or trisomy 21.
Centene Corporation6
“Cell-free fetal DNA testing is medically necessary when all of the following conditions are met,” according to the medical policy paper.
- There is no record that a chromosomal abnormality screening test (e.g., sequential serum screening, quad screen, penta screen, and serum integrated, or contingent) was done during this pregnancy.
- In this pregnancy, there is no documentation of a previous abnormal nuchal translucency test;
Anthem7
“Noninvasive cell-free fetal DNA-based screening for fetal aneuploidy” is an acceptable screening option for fetal aneuploidy (trisomy 13, 18, and 21) in average-risk women carrying a single or twin gestation pregnancy, according to the medical policy document, and is “in accordance with generally accepted standards of medical practice.”
“For singleton pregnancies at greater risk of a sex (X)-linked disease or congenital adrenal hyperplasia, cell-free fetal DNA-based prenatal testing for fetal sex determination is regarded medically required.”
Humana8
CPT codes 81420, 81479, and 81507 are not covered by Humana if they are used to report any test or indication other than those indicated below in the coverage determination section, including, but not limited to:
- Testing for low fetal fraction or test failure that is duplicated or repeated (i.e. throughout the same pregnancy); OR
- During the current pregnancy, duplicate or repeat NIPS testing for chromosomal abnormalities (eg, multiple marker screening with or without 2D ultrasound for nuchal translucency) was performed. OR
- 81422) (eg, Panorama Plus 22q11.2 deletion, MaterniT21 Plus ESS); OR expanded testing of microdeletion/microduplication analysis (eg, DiGeorge syndrome, Prader-Willi syndrome) (ie, 81422) (eg, Panorama Plus 22q11.2 deletion, MaterniT21 Plus ESS); OR
- Monogenic disorders (e.g., beta thalassemia, hemophilia, sickle cell anemia) are screened for; OR
Does Cigna cover genetic testing?
In the general population, genetic testing or gene mapping is not deemed medically required. Cigna covers newborn genetic screening (e.g., metabolic, endocrine, hemoglobin, and other problems) that is done in compliance with state laws.
Does Cigna cover genetic testing during pregnancy?
Cigna will cover the embryo biopsy procedure to extract the cell and genetic testing associated with preimplantation genetic testing (PGT) under the basic medical benefits of the plan if the particular criteria listed below are met.
Does Cigna Open Access Plus cover NIPT?
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.
How many ultrasounds does Cigna cover during pregnancy?
This policy covers the use of obstetric ultrasonography throughout pregnancy. Medically essential are up to two (2) regular two-dimensional (2D) standard or limited obstetrical ultrasound examinations (CPT codes 76801, 76805, 76811, 76815).
How long does it take to get back NIPT?
The results of your NIPT can take up to two weeks to arrive. Your kid is unlikely to have any of the chromosomal diseases evaluated if the result is ‘negative, normal, or low risk.’ If the result is ‘positive,’ ‘abnormal,’ or ‘high risk,’ it means your baby is at risk.
A diagnostic test such as CVS or amniocentesis can be used to confirm an aberrant NIPT result. You should talk to your doctor, midwife, or genetic counselor about your options.
Does Cigna cover prenatal care?
Enroll in the Cigna Healthy Pregnancy, Healthy Babies program if you have a Cigna health coverage. It’s a program that aims to keep you and your baby healthy during your pregnancy and in the days and weeks after birth. Here’s how to do it.
- Ask us anything; your health coach, who has worked as a nurse, will be there for you throughout your pregnancy.
- Purchase a pregnancy diary that includes information, charts, and tools to assist you in having a happy nine months.
You are free to learn as much as you desire. Get live assistance seven days a week, 24 hours a day. Simply dial the number on the back of your Cigna ID card:
- Consult a health coach for advice on anything from how to cope with pregnant discomfort to what foods to avoid, birthing classes, and maternity benefits.
- Alternatively, you can use the features on the myCigna website to track your pregnancy week by week, prepare for birth, and care for your baby.
You could be rewarded for making wise decisions. Your company may offer incentives for participating in a Cigna health plan if you’re enrolled through work. You may be eligible for the following benefits if you participate in and finish the program:*
Does my insurance cover prenatal genetic testing?
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.
What does NIPT test for?
Noninvasive prenatal testing (NIPT), also known as noninvasive prenatal screening (NIPS), is a technique for estimating the likelihood that a fetus may be born with genetic abnormalities. This test examines tiny DNA fragments that circulate in a pregnant woman’s blood. Unlike most DNA, which is located inside the nucleus of a cell, these pieces are free-floating and not contained within cells, and are so referred to as cell-free DNA (cfDNA). When cells die and are broken down, their contents, including DNA, are released into the circulation, these little fragments form. They normally comprise fewer than 200 DNA building blocks (base pairs).
The mother’s bloodstream carries a mixture of cfDNA from her cells and cells from the placenta throughout pregnancy. The placenta is uterine tissue that connects the mother’s blood supply to the fetus. During pregnancy, these cells are lost into the mother’s bloodstream. The DNA of placental cells and the DNA of the fetus are usually identical. The analysis of cfDNA from the placenta allows for the early diagnosis of some genetic disorders without causing harm to the fetus.
NIPT is most commonly used to test for chromosomal diseases caused by an extra or missing copy of a chromosome (aneuploidy). Trisomy 21 (caused by an extra chromosome 21), trisomy 18 (produced by an extra chromosome 18), trisomy 13 (caused by an extra chromosome 13), and extra or missing copies of the X and Y chromosomes are the most common conditions found during NIPT (the sex chromosomes). The test’s accuracy varies depending on the disease.
Additional chromosomal diseases caused by missing (deleted) or copied (duplicated) parts of a chromosome may be detected using NIPT. NIPT is now being used to screen for genetic illnesses caused by single-gene variations (variants). Researchers anticipate that as technology advances and the cost of genetic testing drops, NIPT will become available for a greater number of hereditary diseases.
Because it just needs collecting blood from the pregnant mother and poses no risk to the fetus, NIPT is termed noninvasive. Because NIPT is a screening test, it cannot provide a clear answer as to whether or not a fetus has a genetic disease. The test can only tell you whether your chances of developing certain diseases have increased or decreased. When the fetus is genuinely unaffected, NIPT findings may suggest an increased risk for a genetic abnormality (false positive), or when the fetus is actually affected, the results may indicate a lowered risk for a genetic abnormality (false negative) (false negative). Because NIPT examines both fetal and maternal cfDNA, a genetic abnormality in the mother may be detected.
To detect fetal chromosome abnormalities, there must be enough fetal cfDNA in the mother’s bloodstream. The fetal fraction is the percentage of cfDNA in maternal blood that comes from the placenta. The fetal fraction must be greater than 4% in most cases, which happens around the ninth week of pregnancy. Low fetal fractions can make the test impossible to complete or result in a false negative. Testing too early in the pregnancy, sampling mistakes, maternal obesity, and fetal abnormalities are all reasons for low fetal fractions.
There are several NIPT methods for fetal cfDNA analysis. The most frequent method for determining chromosomal aneuploidy is to count all cfDNA fragments (both fetal and maternal). If the percentage of cfDNA pieces from each chromosome is as expected, the fetus is less likely to have chromosomal abnormalities (negative test result). If the fraction of cfDNA fragments from a specific chromosome is higher than expected, the fetus is more likely to be born with a trisomy (positive test result). A positive screening result indicates that more testing (referred to as diagnostic testing because it is used to diagnose a condition) is needed to confirm the result.