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December 2016 Texas Medicaid Provider Procedures Manual

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook : 4 Noninvasive Prenatal Testing (NIPT)

4
Noninvasive prenatal testing (NIPT) is a benefit of Texas Medicaid when medically necessary for the advanced screening of fetal chromosomal abnormalities in pregnant women who meet specific screening criteria. Genetic screening results, when informative, may influence clinical management decisions.
NIPT may be performed as early as ten weeks gestation for specific fetal aneuploidy screening, restricted to Trisomy 13, Trisomy 18, Trisomy 21, and fetal sex chromosome aneuploidy (SCA). To determine NIPT appropriateness, a baseline ultrasound, if not previously performed, is strongly recommended to confirm viability, the number of fetuses, and gestational dating.
If NIPT provides an abnormal screening result, invasive prenatal confirmatory diagnostic testing is strongly encouraged due to the potential risk of a false-positive result from NIPT. Confirmatory diagnostic tests include chorionic villus sampling (CVS) or amniocentesis.
It is recommended that clients who receive an indeterminate result be offered further genetic counseling, comprehensive evaluation with ultrasound, and diagnostic testing due to the increased risk of aneuploidy. Higher body mass index (BMI) may affect NIPT results. Clients weighing more than 250 pounds are at risk of having an inconclusive result from NIPT.
NIPT does not assess the risk for fetal anomalies such as neural tube defects or ventral wall defects. Ultrasound evaluation and maternal serum alpha-fetoprotein screening should be offered for these risk assessments.
NIPT must be ordered by the medical provider rendering direct care to the client. The provider must order the most appropriate test based on the client’s medical history and the results of previous screenings, if available. The provider must clarify for the client the option to decline, and the provider must document that the option to decline was clearly provided in the client’s medical record.
Note:
Some noninvasive prenatal tests include an extended panel that screens for microdeletions and additional trisomies, such as T16 and T22. However, this use has not been validated, and the “opt-out” box on the requisition form should be checked.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.