24-589 Expanded Prenatal Screening Program
Date: 06/14/24
Follow the process and billing guidelines outlined below
Effective April 1, 2024, the California Department of Health (CDPH) Prenatal Screening Program issued a letter1 (PDF) adding sex chromosome aneuploidy (X, XXY, XYY, XXX) screening to its cell-free DNA (cfDNA) prenatal screening panel. This is in addition to the already available fetal autosomal trisomies (trisomy 21, trisomy 18, and trisomy 13) offered in the first and second trimesters of pregnancy.
Physicians and other providers must use the correct diagnosis code, correct testing codes and a California Prenatal Screening (PNS) Program-contracted lab for prenatal genetic screening to be covered under the PNS program.
Billing guidelines
Refer to the appropriate codes when billing for PNS.
The billing process for Medi-Cal remains unchanged. The PNS program is being expanded to include sex chromosome screening as stated above.
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Code | description |
|---|---|
CPT Code: 81420 | Fetal chromosomal aneuploidy (trisomy 13, 18 and 21), including sex chromosome aneuploidy (X, XXY, XYY, XXX) screening |
PLA Code: 0327U | Fetal aneuploidy (trisomy 13, 18 and 21) |
CPT Code: 82105 | Alpha-fetoprotein, maternal serum |
Diagnosis code: Z360 (no decimal or additional digits) | Encounter for antenatal screening of mother |
Referrals to PNS Program-contracted labs and ordering supplies for blood draws
The PNS Program referral form is available on the PNS Program website and must be used with members referred to a PNS Program-contracted lab for services to be covered under the PNS Program.
To order blood draw supplies and other supplies for members on Commercial plans or Medi-Cal, physicians and other providers must use forms available via the PNS Program website > Information for Providers > Ordering Supplies > Clinician Offices and Hospitals Supplies Ordering.
Additional information
Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on the
provider portal.
If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141.
1https://www.cdph.ca.gov/Programs/CFH/DGDS/CDPH%20Document%20Library/PNS%20Documents/Prenatal_Insurer_Letter_2024.pdf.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.
This information applies to Medi-Cal in Imperial county.