QualChoice will cover
fetal genetic testing under certain circumstances:
described under the policy on BI017 Amniocentesis.
Chorionic villus sampling
(CVS) is described under the policy on BI072 Chorionic Villus Sampling.
The first trimester
“triple test” or early second trimester “quadruple test” is covered under
The parents must receive
counseling before the tests are done.
The parents must be
willing to consider pregnancy termination in the case that a sufficient
abnormality is detected. See our policy on BI206 Elective Abortion.
There must be an
appropriate indication for the procedure (defined by QualChoice in section 2
All three tests must be
ordered at essentially the same time by the physician performing/interpreting
The indications for
specific fetal genetic testing recognized by QualChoice are:
A history of either
mother or father having previously parented a genetically abnormal child.
A family history of an
inheritable disease for which there are characteristics that can be defined and
detected in cell culture:
This would apply only to
CVS or Amniocentesis.
If the disease is a
recessive trait, BOTH parents must have been tested and found to be carriers.
If the disease is an
autosomal dominant trait, EITHER parent must have been tested and found to be a
carrier (or a victim) of the disease.
If the disease is an
X-linked trait, then either:
Father has the disease;
Mother is a carrier.
Cell free fetal DNA screening for aneuploidy is covered in
singleton pregnancies when
the sample is collected
between 9-20 weeks gestation.
Testing for Cri-du-chat
and DiGeorge syndrome is not done routinely and therefore requires
Screening for congenital
abnormalities with five analytes is considered experimental/investigational and
Used In This BI:
76813 Ob us nuchal meas 1 gest
76814 Ob us nuchal meas add-on
81599 Unlisted multianalyte assay
with algorithmic analysis
81508 Fetal congenital abnormalities,
biochemical assays of two proteins
81511 Fetal congenital abnormalities,
biochemical assay of 4 analytes (AFP, uE3, hCG, DIA)
84163 PAPP-A serum
84702 Chorionic gonadotropin test
81507 Fetal aneuploidy DNA sequence
analysis using maternal serum (chrom 13, 18, 21)
81420 Fetal chrom analysis panel using mat
serum (chrom 13, 18, 21)
81422 Fetal chrom microdeletion anal using
mat serum (DiGeorge syndr, Cri-du-Chat syndr)
0009M Fetal aneuploidy trisomal risk Deleted code eff 01/01/2020
FTL CGEN ABNOR BIOCHEM ASSAY 3 ANALYTES ALG (new code 10/1/19)
FTL CGEN ABNOR&PRNT COMP 5 ANALYTES ALG (new code 10/1/19): E/I
FTL CGEN ABNOR&PRNT COMP 5 ANAL ASSMT Y CHRMSM (new code 10/1/19): E/I