Obstetric Clinician Policy Letter
Letter Template: Obstetric Clinician Policy
Dear [insert payer contact],
As an obstetrician-gynecologist who provides services to your clients, I’m writing to urge that you work to advance women’s health care by expanding coverage to non-invasive prenatal testing, including the newest technology, cell-free DNA screening for all women, regardless of maternal age or risk of chromosomal abnormality.
The American College of Obstetricians and Gynecologists (ACOG) updated the clinical information and recommendations for Screening for Fetal Chromosomal Abnormalities in 2020. The updates include:
- Chromosomal abnormalities occur in approximately 1 in 150 live births and the incidence of fetal chromosomal abnormalities increases as a woman ages but can affect patients at any age and is not related to race or ethnicity.
- Prenatal genetic screening (serum screening with or without nuchal translucency [NT] ultrasound or cell-free DNA screening) AND diagnostic testing (chorionic villus sampling [CVS] or amniocentesis) options should be discussed and offered to all pregnant patients regardless of age or risk of chromosomal abnormality.
- Patients who prefer comprehensive prenatal detection of as many chromosomal aberrations as possible should be offered diagnostic testing and CMA.
- Cell-free DNA testing is the most sensitive and specific screening test for common fetal aneuploidies; it is not equivalent to diagnostic testing. Even if patients have a negative screening test result, the patient may choose diagnostic testing later.
- All patients should be offered a second-trimester ultrasound for fetal structural defects.
[Insert personal experience/narrative here]
One or more of the following codes should be considered for coverage:
- 81420: Fetal chromosomal aneuploidy (e.g., 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
- 81422: Fetal chromosomal microdeletion(s) genomic sequence analysis (e.g., DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood
- 81479: Unlisted molecular pathology procedure
- 81507: Fetal aneuploidy (trisomy 21, 18 and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy
- 0060U: Twin zygosity, genomic targeted sequence analysis of chromosome 21, using circulating cell-free fetal DNA in maternal blood
- 0168U: Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma without fetal fraction cutoff, algorithm reported as a risk score for each trisomy
In addition, I request that the coverage be available without the burden of prior authorization.
This policy is essential to improving access to quality care for all pregnant patients and reducing health inequities. I respectfully request that your policies align with the national standards, as indicated by ACOG.
[sender name and credentials]