Medi-Cal – New Billable Codes for CDPH Genetic Disease Screening Program and PE4PW

Effective retroactively for dates of service on or after September 19, 2022, the following CPT^® codes are billable under the California Department of Public Health (CDPH) Genetic Disease Screening Program (GDSP):

Code	Description
0327U	Fetal aneuploidy (trisomy 13, 18, and 21), DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy, includes sex reporting, if performed
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
82105	Alpha-fetoprotein (AFP); serum

Additionally, CPT codes 81420 and 82105 have been added as benefits under the Presumptive Eligibility for Pregnant Women (PE4PW) program.

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because Medi-Cal had not yet implemented the system changes to support appropriate adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

Source: https://files.medi-cal.ca.gov/pubsdoco/bulletins/artfull/gm202304.aspx#msdynttrid=Nj4-LMrzSvA_-P9nQVxnx6tuoTfhKFCgdrIwQNXsFMY