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Excellus BlueCross BlueShieldAll Plans · Coverage · Genetic Disease (Inherited Disease) · NY · Genetics, Pediatrics, OB-GYNMedium impact

Chromosomal Microarray (CMA) Analysis for Prenatal Evaluation and Evaluation of Patients with Developmental Delay/ Intellectual Disability or Autism Spectrum Disorder 2.02.42

Effective date
Nov 20, 2025
Identified
Jun 20, 2026

Summary

Excellus BlueCross BlueShield policy 2.02.42 covers chromosomal microarray analysis (CMA) for children with apparent nonsyndromic developmental delay or intellectual disability, autism spectrum disorder, or multiple anomalies not specific to a well-delineated genetic syndrome, and for pregnant patients undergoing invasive prenatal diagnostic testing. The 11/20/25 annual review removed the policy criteria for FMR1 gene analysis and the criterion that genetic test results have the potential to impact clinical management. The current effective date is November 20, 2025, and CMA used to confirm a disorder that is routinely diagnosed on clinical evaluation alone is considered not medically necessary.

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What to do

Action · 8 steps
01REQUIREMENTS: Testing is requested only after the parent(s) have had face-to-face genetic counseling with a healthcare professional who has appropriate genetics training and experience, and after any indicated biochemical tests for metabolic disease have been performed with non-diagnostic results.
02When family history or phenotype suggests a specific syndrome, document the results of targeted testing for the associated mutation before CMA, or document the rationale for CMA if targeted testing was not performed.
03Document a reasonable expectation based on family history, pedigree analysis, risk factors, or symptomatology, and document how test results will impact treatment or medical management.
04CMA should not be ordered without informed consent, which should be documented in the medical record.
05For prenatal CMA during invasive prenatal diagnostic testing, the testing must be performed by a qualified laboratory and offered in a setting with adequately trained providers for pre- and post-test genetic counseling.
06Genetic testing is appropriate only when performed by a laboratory certified under CLIA.
07Coverage is contract dependent and applies only to members with a valid contract, not to family members without a valid contract.
08CMA for other delayed development, such as idiopathic growth or language delay, is investigational.

Codes mentioned

812288122981349S3870F84.0G90.1Z13.4Z13.828Z13.84Z13.89Z13.9

Original notice

Chromosomal Microarray (CMA) Analysis for Prenatal Evaluation and Evaluation of Patients with Developmental Delay/ Intellectual Disability or Autism Spectrum Disorder 2.02.42
excellusbcbs.com · Always check the source before changing claims.
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Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesGeneticsPediatricsOB-GYNCode 81228Code 81229Code 81349Code S3870Code F84.0Code G90.1Code Z13.4Code Z13.828Code Z13.84Code Z13.89Code Z13.9

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