Does Ambetter require prior authorization for 81422?

Ambetter lists 81422 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for 81422?

AmeriHealth Caritas lists 81422 on AmeriHealth Caritas Louisiana Act 233 prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 81422?

Anthem BCBS lists 81422 on List of items and services that require prior authorization (Medicaid IN) for medicaid managed plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 81422?

BCBS Arizona lists 81422 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 81422?

BCBS Illinois lists 81422 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 81422?

There are 6 tracked policy changes affecting CPT 81422, including updates from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

How do I get notified when CPT 81422 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 81422. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 81422?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

PAYER POLICY CHANGES

81422 Insurance Policy Changes

Q: Which payers have updated policy for CPT 81422?

Payers that have issued tracked updates for CPT 81422 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna, Blue Cross Blue Shield of Rhode Island.

CPT 81422 is referenced in 6 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81422 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Noninvasive Prenatal Screening for Fetal Aneuploidies, Microdeletions, Single-Gene Disorders, and Twin Zygosity Using Cell-Free Fetal DNA
Nucleic acid sequencing-based testing of maternal plasma to screen for trisomy 21, 18, and 13 may be considered medically necessary in individuals with singleton pregnancies, and karyotyping is needed to exclude a false-positive result. Sequencing-based testing for trisomy 21 in twin or multiple pregnancies, for fetal sex chromosome aneuploidies, for microdeletions, and for twin zygosity is considered investigational, as are Vanadis NIPT for trisomy 21, 18, and 13 and NIPT for single-gene disorders in all situations. Effective 10/01/2026, CPT 0663U was added as investigational, and effective 07/01/2026, CPT 0633U was added as investigational and CPT 0488U was revised.
Excellus BlueCross BlueShield · Effective Aug 17, 2026Medium impact
Non-Invasive Prenatal Testing - (Effective Date - 2026-08-17) 2.02.25
Cell-free DNA noninvasive prenatal testing is medically appropriate for screening for trisomy 21, 13 and 18 in singleton pregnancies, and serum analytes combined with first-trimester nuchal translucency ultrasound is medically appropriate for the same screen. Cell-free DNA testing for fetal RhD genotype may be medically appropriate when all of these are met: the pregnancy may be at risk for alloimmunization, paternal antigen typing is unavailable or heterozygous, and amniocentesis is declined or contraindicated. Multiple gestation NIPT, other aneuploidies, microdeletions (CPT 81422), fetal sex chromosome aneuploidy, single-gene disorder screening, rolling circle replication screening, and fetal nasal bone length are investigational, and twin zygosity testing (CPT 0060U) is not medically necessary.
Excellus BlueCross BlueShield · Effective Aug 17, 2026Medium impact
Non-Invasive Prenatal Testing - (Effective Date - 2026-08-17) 2.02.25
Excellus BlueCross BlueShield medical policy 2.02.25, Non-Invasive Prenatal Testing, has a current effective date of August 17, 2026. NIPT using cell-free DNA to screen for trisomy 21, trisomy 13 and trisomy 18 is medically appropriate for singleton pregnancies. Measurement of cell-free DNA for fetal RhD genotyping is medically appropriate when all of its listed criteria are met. NIPT is investigational for multiple gestation pregnancies, aneuploidies other than trisomy 21, 13 and 18, microdeletions, fetal sex chromosome aneuploidy, single-gene disorder screening, rolling circle replication cell-free DNA screening, and measurement of fetal nasal bone length. The 04/16/26 annual review changed the RhD genotyping stance from investigational to medically appropriate when criteria are met, and PLA code 0449U was removed and relocated to CMP#4.01.03.
Aetna · Identified Aug 18, 2026Medium impact
Maternal Biomarker Screening for Fetal Conditions (CPB 0464, reviewed 2026-07-17)
Aetna covers cell-free DNA fetal RhD genotyping when the pregnancy may be at risk for alloimmunization, paternal antigen typing is unavailable or heterozygous, and amniocentesis is declined or contraindicated. Multiple serum marker testing is covered for pregnant women who have been adequately counseled and want information on their risk of having a Down syndrome fetus, and NIPT for fetal aneuploidy (trisomy 13, 18 and 21, and sex chromosome aneuploidy) is covered for all pregnant women with the listed tests. Performing more than one screening test, such as NIPT with multiple marker screening, is considered not medically necessary, and cell-free DNA screening for microdeletion syndromes, rare autosomal trisomies, single-gene and multi-gene screening, and other listed approaches are considered experimental, investigational, or unproven.
Excellus BlueCross BlueShield · Identified Jun 20, 2026Medium impact
Non-Invasive Prenatal Testing 2.02.25
Excellus BlueCross BlueShield policy 2.02.25 finds non-invasive prenatal testing (NIPT) medically appropriate to screen for trisomy 21, 13 and 18 in singleton pregnancies, and finds NIPT for twin zygosity not medically necessary. The policy lists NIPT as investigational for multiple gestations, other aneuploidies, microdeletions, fetal sex chromosome aneuploidy, single-gene disorders, rolling circle replication screening, fetal nasal bone measurement and fetal RhD genotyping. A policy edit dated 05/13/26 removed Vasistera as an example for single-gene disorder testing and states that Vasistera is a limited NIPT for common chromosomal aneuploidies that is investigational.
Blue Cross Blue Shield of Rhode Island · Identified Jun 20, 2026Medium impact
January 2017
Historical Blue Cross Blue Shield of Rhode Island provider update items dated 2016 and 2017 include coverage and billing changes that have passed. Prescription drug claims moved to Prime Therapeutics from January 1, 2017, and primary care providers were required to submit specialist referrals through the web-based referral management tool for dates of service on or after that date. Other dated changes include prior authorization for artificial cervical disc insertion from February 1, 2017, no prior authorization for CPT 81507 and covered status for CPT 81420 for non-invasive prenatal testing from January 1, 2017, and BlueCHiP for Medicare coverage of prostatic urethral lifts from January 1, 2017. Because these dates have passed, confirm current applicability before acting.

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Noninvasive Prenatal Screening for Fetal Aneuploidies, Microdeletions, Single-Gene Disorders, and Twin Zygosity Using Cell-Free Fetal DNA

Non-Invasive Prenatal Testing - (Effective Date - 2026-08-17) 2.02.25

Non-Invasive Prenatal Testing - (Effective Date - 2026-08-17) 2.02.25

Maternal Biomarker Screening for Fetal Conditions (CPB 0464, reviewed 2026-07-17)

Non-Invasive Prenatal Testing 2.02.25

January 2017

Prior authorization required in some cases

Prior authorization required in some cases

Prior authorization required in some cases

Does Ambetter require prior authorization for 81422?

Does AmeriHealth Caritas require prior authorization for 81422?

Does Anthem BCBS require prior authorization for 81422?

Does BCBS Arizona require prior authorization for 81422?

Does BCBS Illinois require prior authorization for 81422?

What insurance policy changes affect CPT 81422?

Which payers have updated policy for CPT 81422?

How do I get notified when CPT 81422 policy changes?

Why do payers change policies for CPT 81422?