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Fetal Aneuploidy Testing

Date: 06/12/25

A Message for Medicaid Providers. Please share with your clinical team.

The following is a reminder of KMAP Requirements for Fetal Testing

Fetal Aneuploidy Testing (codes 81420 and 81507):

Routine screening of all pregnancies is not currently covered by KanCare. Prior authorization is required for fetal aneuploidy testing, and the following guidelines apply per the Kansas Medical Assistance Program Fee-for-Service Provider Manual, Professional:

  • Fetal aneuploidy testing codes 81420 and 81507 are covered for at-risk pregnancies when billed with a covered ICD-10 diagnosis code. Fetal aneuploidy testing is limited to coverage of one CPT code per pregnancy (270 days).
  • DNA-based noninvasive prenatal tests of fetal aneuploidy are proven and medically necessary as screening tools for trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) or trisomy 13 (Patau syndrome) in any one of the following circumstances:
  • Fetal Testing
    • Maternal age of 35 years or older at delivery
    • Fetal ultrasound findings indicating an increased risk of aneuploidy
    • History of prior pregnancy with trisomy
    • Positive first or second trimester screening test results for aneuploidy
    • Parental balanced Robertsonian translocation with an increased risk of fetal trisomy 13 and 21
  • DNA-based noninvasive prenatal tests of fetal aneuploidy are unproven and NOT medically necessary for all other indications including, but not limited to, the following:
    • Multiple gestation pregnancies
    • Screening for microdeletions
    • Screening for sex chromosome aneuploidies

Prior authorization is required for the above listed testing, and medical records must be submitted to demonstrate medical necessity as defined above. When medical necessity is not demonstrated in accordance with KMAP guidelines, authorization cannot be approved, and the lab claim will not be paid.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call us at the number below: