MedicaidCoverageHigh impact
26-1038 Order Prenatal Screening Through Approved Programs and In-Network Laboratories
Health Net·CA · OB-GYN, Family Medicine, Internal Medicine·Prior Authorization
We identified it
Aug 29, 2026
Summary
This new Medi-Cal policy (Imperial County) establishes specific ordering and laboratory requirements for prenatal screening services to prevent claim denials. Providers must order prenatal aneuploidy screening (CPT 81420) through the California Department of Public Health program only, must NOT order the BillionToOne carrier screening panel (CPT 0449U) as it is not covered, and must use in-network laboratories (Labcorp, Quest) for standard prenatal carrier screening with applicable CPT codes.
Action Required
Immediately: (1) Billing team must update billing software and encounter forms to prohibit ordering CPT 0449U (BillionToOne prenatal carrier screening panel) — this service is NOT covered and will result in claim denials. (2) Providers must be directed to order CPT 81420 (prenatal aneuploidy screening) ONLY through the California Department of Public Health Prenatal Screening Program, not through Medi-Cal Plan authorization — Plan authorization requests will be denied. (3) For standard prenatal carrier screening, ensure billing team verifies use of in-network laboratories (Labcorp, Quest Diagnostics) and applies correct individual component CPT codes per Plan requirements. (4) Add compliance alert to provider ordering portal flagging these three distinct pathways. Contact Community Health Plan of Imperial Valley at 833-236-4141 for coverage questions or in-network lab verification. Failure to comply will result in claim denials and payment delays for affected beneficiaries.