Prior Authorization required for 81507

A prior authorization is required for 81507 Fetal aneuploidy (trisomy 21, 18, 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy. Criteria for consideration for serum SNA testing includes: previous pregnancy with fetal trisomy or family history of trisomy (646.3; V18.4), maternal age greater than 35 at delivery (v23.81;v23.82), or 1-2 fetal structural abnormalities on US (v28.3;v28.89) or Screen positive result for aneuploidy on first trimester test (v23.87; V72.69).