CommercialCoverageHigh impact
Noninvasive Down Syndrome Screening (CPB 0282, reviewed 2026-04-17)
Aetna·OB-GYN, Radiology, Genetics·Medical Policy
Effective date
Apr 17, 2026
We identified it
Aug 18, 2026
Summary
Aetna updated its noninvasive Down syndrome screening policy (CPB 0282, effective 2026-04-17) to clarify medically necessary screening methods and explicitly restrict duplicate testing. Key change: CPT codes 76813/76814 (nuchal translucency ultrasound) should NOT be billed when patients have already received negative cell-free DNA (cfDNA) screening results, even if NT measurement is obtained during a 10-14 week ultrasound.
Action Required
IMMEDIATE (By 2026-04-17): Billing team must implement new edits in billing software to prevent billing of CPT 76813/76814 when patient has documented negative cfDNA screening (NIPT with cell-free DNA) results in current pregnancy. Specifically: (1) Flag claims for CPT 76813 and 76814 for patients with prior cfDNA results in same pregnancy episode; (2) Reject or route to manual review any claim combining 76813/76814 with cfDNA testing codes (81420, 81507) within same pregnancy; (3) Train billing staff and providers that NT ultrasound-only claims following negative cfDNA results will be denied; (4) Update claim denial response templates to cite this policy restriction. Coordinate with providers to document cfDNA screening status at time of ultrasound ordering. Failure to implement these edits will result in claim denials and potential recovery demands from Aetna.