UnitedHealthcare Eliminates Prior Authorization for Non-Invasive Prenatal Testing (NIPT) Effective April 1, 2025
As of April 1, 2025, UnitedHealthcare will not require prior authorizations for Cell-Free Fetal DNA Testing under its commercial plans, community plans, and individual exchange plans in the United States.
Reason for the change
The healthcare experience simplification initiative represents a broad-based strategy to benefit members and network healthcare professionals. These services will not require prior authorizations starting April 1, 2025, but reimbursement depends on the proper medical necessity of the tests according to medical policy guidelines.
Affected procedures
The following procedures fall under the scope of this change:
- 0327U: The procedure 0327U analyzes fetal aneuploidy (trisomy 13, 18, and 21) through DNA sequence analysis of selected regions using maternal plasma, which produces a risk score for each trisomy and includes sex reporting when performed.
- 81420: The genomic sequence analysis panel for fetal chromosomal aneuploidy detection through circulating cell-free fetal DNA in maternal blood must include analysis of chromosomes 13, 18, and 21 (81420).
- 81507: The test analyzes DNA sequences from selected regions in maternal plasma to generate risk scores for trisomies 21, 1,8, and 13.
Affected plans
This change affects the following plans:
- UnitedHealthcare Insurance Company
- UnitedHealthcare of the Mid-Atlantic, Inc.
- UnitedHealthcare Plan of the River Valley, Inc. and UnitedHealthcare Insurance Company of the River Valley
Oxford Health Insurance, Inc. - UnitedHealthcare Level Funded (formerly All Savers Insurance Company and All Savers Life Insurance Company of California)
- Neighborhood Health Partnership, Inc.
- UnitedHealthcare Individual Exchange plans operate under two names: UnitedHealthcare Individual & Family ACA Marketplace plans and Rocky Mountain Health Plans, which include Off-Exchange plans with Monument Health HMO, Monument ONE, Rocky Mountain Sky Plans, and Rocky Mountain Valley Plans.
- UnitedHealthcare Community Plans
Provider Services maintains a contact number on member health care ID cards, which providers can use to ask questions about this NIPT prior authorization policy change. Healthcare professionals must consult the full medical policy containing complete coverage criteria and documentation needs for non-invasive prenatal testing.
UnitedHealthcare maintains its dedication to burdensome process reduction by implementing an efficient process for NIPT service oversight. UnitedHealthcare maintains a strong partnership with providers to provide excellent prenatal care services to members.
