CommercialCoverageHigh impact
Maternal Biomarker Screening for Fetal Conditions (CPB 0464, reviewed 2026-07-17)
Aetna·OB-GYN·Medical Policy
Effective date
Jul 17, 2026
We identified it
Aug 18, 2026
Summary
Aetna has updated its maternal biomarker screening policy (CPB 0464) to clarify coverage for noninvasive prenatal testing (NIPT), fetal RhD antigen detection, and multiple marker screening. The policy specifies which tests are medically necessary, explicitly states that performing multiple screening tests is not covered, and lists numerous tests classified as experimental/investigational. Billing teams must ensure claims are submitted only for covered tests meeting medical necessity criteria and reject claims for duplicate screening approaches.
Action Required
By 2026-07-17, billing team must: (1) Update billing system edits to prevent dual submission of NIPT and multiple marker screening for the same pregnancy (claims with both will be denied per ACOG guidelines cited in policy); (2) Verify all maternal biomarker screening claims include medical necessity documentation matching policy criteria (e.g., for RhD testing: maternal RhD status or red cell antibodies, paternal typing unavailable/heterozygous, amniocentesis declined/contraindicated); (3) Create denial/rejection workflow for experimental tests listed in policy including 0060U, 0341U, 0489U, 0536U, 0633U, 81422, and single/multi-gene screening codes - flag these as non-covered and do not bill to Aetna; (4) Train billing and authorization staff on covered vs. non-covered NIPT test names (approved tests include ClariTest Core, MaterniT21 PLUS, Panorama, QNatal Advanced, Unity Aneuploidy Screen, Verifi; reject MaterniT Genome with microdeletions, Panorama with microdeletions, QNatal with optional microdeletions); (5) Update encounter templates and provider education materials to specify that only ONE screening approach per pregnancy is covered. Failure to comply will result in claim denials and patient responsibility billing issues.