Fetal Screening Procedures Reimbursable Under PE Program

Effective for dates of service on or after May 1, 2014, CPT code 81508 (fetal congenital abnormalities, biochemical assays of two proteins [PAPP-A and hCG (any form)], utilizing maternal serum, algorithm reported as risk score) and CPT code 81511 (fetal congenital abnormalities, biochemical assays of four analytes [AFP, uE3, hCG (any form), DIA], utilizing maternal serum, algorithm reported as risk score) are reimbursable under the Presumptive Eligibility (PE) program. Code 81508 (performed in the first trimester) and code 81511 (performed in the second trimester) are screening markers for the detection of Down syndrome using fetal ultrasound markers combined with maternal serum assessment. These screenings are intended to improve the accuracy of biochemical screening and are current Medi-Cal benefits.

Source: General Medicine | April 2014 | Bulletin 478