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Noninvasive Prenatal Screening Benefits to Change for Texas Medicaid July 1, 2023

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after July 1, 2023, noninvasive prenatal screening (NIPS) benefits will change for Texas Medicaid.

Overview of Benefit Changes

Major changes to this medical benefit include the following:

  • Updated benefit eligibility criteria
  • Removed prior authorization requirement

Benefit Criteria

NIPS will be a benefit for clients who have a confirmed intrauterine singleton pregnancy dated at least ten weeks gestation.

Note: The client will no longer be required to meet specific high-risk criteria.

Procedure codes 81420 and 81507 will no longer require prior authorization but will remain limited to once per pregnancy. Additional screenings will not be reimbursed.

For more information, call the TMHP Contact Center at 800-925-9126.