Skip to main content

Medical Policy Update: Invasive Prenatal (Fetal) Diagnostic Testing

Effective January 19, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for invasive prenatal (fetal) diagnostic testing used to identify pathogenic genetic alterations in fetuses at increased risk based on prenatal screening or in women who choose to undergo diagnostic testing due to other risk factors for patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans.

We encourage you to access our Medical Policy Manual to review the guidelines of our medical policy, Invasive Prenatal (Fetal) Diagnostic Testing1.


Based on the guidelines of our medical policy, Invasive Prenatal (Fetal) Diagnostic Testing, CPT® codes 81228 and/or 81229 included on claims for services provided on and after January 19, 2018 to patients enrolled in Horizon BCBSNJ MA plans will be denied as experimental/investigational non-covered services regardless of the submitted diagnosis code(s).

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after January 19, 2018.

1Previous policy titled Invasive Prenatal (Fetal) Molecular and Cytogenetic Testing.

CPT® is a registered mark of the American Medical Association.

Published on: December 20, 2017, 10:46 a.m. ET
Last updated on: December 20, 2017, 10:47 a.m. ET