Maryland Medicaid Now Requires Prior Auth for Select NIPT Tests

Applies to CPT® codes 81422 and 81479

To meet state requirements, starting June 1, 2025, UnitedHealthcare Community Plan of Maryland requires prior authorization for two types of Non-Invasive Prenatal Testing (NIPT) for its members. This applies to CPT codes 81422 and 81479 when used for:

• NIPT for trisomy screening and sex chromosomal analysis.
• NIPT for trisomy screening, sex chromosomal analysis, and microdeletions.

How to Submit a Request

• Visit UHCprovider.com and click "Sign In" at the top-right corner.
• Log in with a One Healthcare ID and password.
• For new users without a One Healthcare ID, register on the provider portal registration page.
• From the menu, select "Prior Authorizations."
• In the Prior Authorization and Notification tool, scroll to “Create a new notification or prior authorization request” and click "Create New Submissions."
• Enter the required information and submit the request.

If UnitedHealthcare does not receive a prior authorization request before the service date, it will deny the claim, and the provider cannot balance bill members.

Resources

• The Maryland Department of Health Non-Invasive Prenatal Testing clinical criteria provide coverage determination guidelines, documentation requirements, and additional details.
• Providers can refer to the Prior Authorization and Notification Interactive User Guide for further assistance.

Questions?

For any questions, providers should visit the Prior Authorization and Notification page.