MedicaidCoverageMedium impact
Expanded Spinal Muscular Atrophy (SMA) Carrier Screening
Healthfirst·NY · OB-GYN, Family Medicine·Provider Update
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
NYS Medicaid has expanded coverage for Spinal Muscular Atrophy (SMA) carrier screening to all members who are planning to become or already are pregnant, effective October 1, 2023. A new CPT code 81329 has been established for this testing, which is covered once per lifetime and no longer requires prior documentation.
Action Required
Immediately: Billing team must update system to use CPT code 81329 for all SMA prenatal carrier testing for NYS Medicaid members. Update encounter forms and billing software to reflect once-per-lifetime limitation. Remove any prior documentation requirements for SMA carrier screening claims as they will no longer pend for approval.