MedicaidCoverageMedium impact
24-587 Expanded Prenatal Screening Program
Health Net·CA · OB-GYN, Family Medicine·Reimbursement
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Summary
California's Prenatal Screening Program now covers sex chromosome aneuploidy screening (X, XXY, XYY, XXX) in addition to existing trisomy screening. Providers must use specific CPT codes and contracted labs for coverage under the program.
Action Required
Immediately: Billing team must update prenatal screening procedures to use CPT 81420 for expanded chromosomal aneuploidy screening including sex chromosome screening, and diagnosis code Z360 (without decimals). Ensure all prenatal genetic screening is referred to PNS Program-contracted labs only and use the required PNS Program referral form available on their website. Update encounter forms and billing system to reflect expanded coverage.