Expanded Medicaid Managed Care Coverage for Trisomy Screening Begins January 1, 2015

Date Issued: 12/10/2014

Effective January 1, 2015, Medicaid Managed Care plans cover noninvasive prenatal trisomy screening using cell-free fetal DNA for certain high-risk singleton pregnancies. One or more of the following criteria must be met for the testing to be a covered service:

  • Either parent has a family history of an aneuploidy in a 1st* or 2nd** degree relative.
  • The pregnant woman is of advanced maternal age (defined by the American College of Obstetricians and Gynecologists [ACOG] as 35 years or older at the time of delivery).
  • Standard serum screening or fetal ultrasonographic findings indicate an increased risk of an aneuploidy.
  • Parent(s) have a history of a previous pregnancy with a trisomy.
  • Either parent is known to have a Robertsonian translocation.

EmblemHealth contracts with Quest Diagnostics to provide outpatient clinical laboratory services to our members. To ensure that members receive the highest level of their plan benefits, please send laboratory specimens to Quest Diagnostics.

Note: Quest is able to provide most laboratory services. For specialty lab tests not available from Quest, we have contracts with other labs. For network hospitals with their own lab contracted with EmblemHealth, physicians may use this lab rather than Quest if applicable.

*Parent, child or sibling
**Grandparent, aunt or uncle, niece or nephew, or grandchild