Prior Authorization for Newborn Genetic Testing

  • November 21, 2019

    Premera is no longer requiring prior authorization and medical necessity review for three genetic tests in newborns. This means that starting October 6, 2019, our providers don’t need to submit requests through our partner AIM Specialty Health® (AIM) when the following codes are submitted individually or with each other.

    • 81220: CFTR (cystic fibrosis transmembrane conductance regulator) (i.e. cystic fibrosis) gene analysis; common variants (i.e. ACMG/ACOG guidelines)
    • 81329: SMN1 (survival of motor neuron 1, telomeric) (i.e. spinal muscular atrophy) gene analysis; dosage/deletion analysis (i.e. carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed
    • 81420: Fetal chromosomal aneuploidy (i.e. trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21

    Larger panels including these tests and other genetic testing services for newborns may still require prior authorization. Providers can find the review requirements by using our code check tool, code list, or prior auth tool.

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