CommercialCoverageMedium impact
Prenatal Genetic Testing 4.01.03
Excellus BlueCross BlueShield·OB-GYN, Family Medicine·Genetic Disease (Inherited Disease)
Effective date
May 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their prenatal genetic testing policy (4.01.03) effective May 15, 2026, establishing specific medical necessity criteria for genetic testing during pregnancy, including carrier screening, diagnostic testing, and preimplantation genetic diagnosis. The policy sets limits on non-targeted carrier screening panels to a maximum of 22 genes and requires specific clinical indications for coverage.
Action Required
By May 15, 2026: OB-GYN practices and genetic counselors must update prior authorization processes to align with new medical necessity criteria for prenatal genetic testing. Ensure documentation includes specific qualifying conditions (advanced maternal age 35+, abnormal screening results, family history, etc.) before ordering tests. Limit non-targeted carrier screening panels to maximum 22 genes to avoid denials. Update EMR templates to capture required clinical indicators and ensure CLIA-certified laboratories are used for all genetic testing.