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Excellus BlueCross BlueShieldCommercial · Coverage · Lab Tests (pathology) · NY · Genetics, OB-GYN, PathologyMedium impact

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

Effective date
Aug 17, 2026
Identified
Jun 20, 2026

Summary

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.

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What to do

Action · 6 steps
01Already effective August 17, 2026: Billing team, for genetic testing claims, confirm the member has a valid contract, because coverage applies only to members with a valid contract and is not provided for family members without one.
02Keep documentation of a reasonable expectation of a genetically inherited condition based on family history, pedigree analysis, risk factors or symptomatology, and document how the test results will impact treatment or medical management.
03When family history or phenotype suggests a specific syndrome, document targeted testing for the associated mutation before any panel testing, or document why panel testing is medically necessary.
04For fetal RhD genotyping, document that the pregnancy may be at risk for alloimmunization due to maternal RhD negative status or maternal red cell antigen antibodies, that paternal antigen typing is unavailable or heterozygous, and that amniocentesis is declined or contraindicated.
05Genetic testing is appropriate only when performed by a laboratory certified under CLIA.
06Review these services against the policy before scheduling or billing them: CPT 81422, 81479, 81599, 0327U and 0489U are marked experimental or investigational, and CPT 0060U for twin zygosity is marked not medically necessary.

Codes mentioned

768137681481420814228147981507815998416384704

Original notice

Non-Invasive Prenatal Testing - (Effective Date - 2026-08-17) 2.02.25
excellusbcbs.com · Always check the source before changing claims.
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Related changes

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Non-Invasive Prenatal Testing - (Effective Date - 2026-08-17) 2.02.25MediumEffective Aug 17, 2026 · Lab Tests (pathology)Non-Invasive Prenatal Testing 2.02.25MediumNo effective date · Lab Tests (pathology)Molecular Testing in the Management of Pulmonary Nodules 2.02.58MediumEffective Oct 22, 2026 · Lab Tests (pathology), Lungs (Respiratory)Gene Expression Profiling for Cutaneous Melanoma 2.02.52MediumEffective Oct 16, 2025 · Cancer Treatment (Oncology)Browse every Excellus BlueCross BlueShield change in the policy list

Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesGeneticsOB-GYNPathologyCode 76813Code 76814Code 81420Code 81422Code 81479Code 81507Code 81599Code 84163Code 84704

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