All PlansCoverageHigh impact
Non-Invasive Prenatal Testing - (Effective Date - 2026-08-17) 2.02.25
Excellus BlueCross BlueShield·OB-GYN, Genetics, Pathology +1 more·Lab Tests (pathology)
Effective date
Aug 17, 2026
We identified it
Aug 26, 2026
Summary
Excellus BlueCross BlueShield updated its Non-Invasive Prenatal Testing (NIPT) policy effective August 17, 2026, establishing coverage criteria for cell-free DNA screening of trisomy 21, 13, and 18 in singleton pregnancies while designating multiple scenarios as investigational (including multiple gestations, microdeletions, sex chromosome aneuploidies, and fetal zygosity testing). The policy requires informed consent, genetic counseling, and CLIA-certified laboratory performance, with abnormal results requiring confirmatory testing via CVS or amniocentesis.
Action Required
By August 17, 2026: Billing team must immediately implement the following changes: (1) Update billing software to approve coverage for NIPT (cell-free DNA testing) for singleton pregnancies screening for trisomy 21, 13, and 18 only; (2) Configure system to DENY claims for investigational NIPT scenarios including CPT 0060U (twin zygosity), CPT 81422 (microdeletions), and NIPT for multiple gestations, sex chromosome aneuploidies, single-gene disorders, Vanadis NIPT, and nasal bone measurement; (3) Add prior authorization workflow requiring documentation of: informed consent from qualified provider/genetic counselor, medical necessity justification, confirmation that abnormal results will be validated with CVS or amniocentesis, and CLIA certification of testing laboratory; (4) Update encounter templates and provider education to require genetic counseling documentation pre-test; (5) Implement claim denial logic for policy statement IV (nuchal translucency screening alone) and V (twin zygosity); (6) Ensure billing staff flag claims lacking required pre- and post-test counseling documentation for denial. Failure to implement these controls will result in incorrect claims being paid for investigational services and potential compliance issues. Reference related policy CMP#4.01.03 for non-targeted prenatal carrier screening panels.