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26-1037 Order Prenatal Screening Through Approved Programs and In-Network Laboratories

Date: 08/28/26

Follow Medi-Cal requirements to help avoid claims denials, payment delays and processing issues

When ordering prenatal screening services for Medi-Cal members, providers must follow specific coding, ordering, laboratory and coverage requirements. Services ordered through the wrong program or laboratory, or services that are not covered, will result in claim denials, payment delays or processing issues.

What providers need to do

Use the table below to confirm coding, ordering, laboratory, and coverage requirements for each service.

Test/Service

Ordering and laboratory requirements

Coverage information

Prenatal aneuploidy screening (CPT 81420)
  • This service is carved out of Medi-Cal managed care coverage.
  • Authorization requests submitted to the Plan will be denied.

BillionToOne prenatal carrier screening panel (CPT 0449U)

Includes CFTR, SMN1, HBB, HBA1 and HBA2 testing

Do not order this panel.

This panel is not a covered
Medi-Cal benefit.

Standard prenatal carrier screening

  • Order individual component tests using the applicable CPT codes.
  • Use an in-network laboratory, such as Labcorp or Quest Diagnostics.

Covered when billed using the applicable CPT codes and Plan requirements are met.

CPT Copyright 2025 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

Questions?

For questions about coverage, coding or in-network laboratories, contact CalViva Health at 888-893-1569.
 

This information applies to Participating Physician Groups (PPGs), Physicians and Practitioners.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.



Last Updated: 08/27/2026