Expanded Coverage for Spinal Muscular Atrophy – Prenatal Carrier Testing

Effective October 1, 2014 Medicaid fee-for-service (FFS), and December 1, 2014 Medicaid Managed Care (MMC) and Family Health Plus (FHPlus) will begin covering prenatal carrier testing for spinal muscular atrophy(SMA). This is covered once in a lifetime. Carrier screening for SMA of the male partner of a pregnancy will be covered if the pregnant female is found to be a carrier. Spinal Muscular Atrophy is a genetic disease caused by mutations or deletions in the SMN1 gene that produces a reduction in the level of survival motor neuron (SMN) protein. This reduction destroys the nerves that control voluntary muscle movement. The muscles that are most often affected are those responsible for head and neck control, breathing, swallowing, crawling and walking. SMA is the leading inherited cause of death in infants. Follow-up genetic counseling should be provided to those who test positive as a carrier of SMA. Use CPT code 81401 to bill for this service.