Coverage for preimplantation genetic testing

Starting July 1, 2021, preimplantation genetic testing (PGT) will be covered as a standard benefit for eligible UnitedHealthcare commercial plan members when they or their partners are carriers for a specific genetic disorder.

Requesting prior authorization

You’ll need to complete the prior authorization process and supply specific medical documentation when requesting PGT for the following CPT® codes:

  • 81228
  • 81229
  • 81479

The following documentation must be included with your prior authorization request:

  • Personal history of the condition, if applicable, including the age at diagnosis
  • Complete family history relevant to the condition being tested
  • Genetic testing results of family member, if applicable, and reason for testing
  • Ethnicity/ancestry if reason for testing
  • Any prior genetic testing results
  • How clinical management will be impacted based on results of genetic testing
  • Genetic counseling (if completed)

What is PGT?

PGT is a genetic test that can be performed on an embryo during the assisted reproductive process. A sample of the embryo is sent to the laboratory to look for changes in genes and/or chromosomes.

PGT tests are performed prior to pregnancy and in vitro fertilization (IVF). This is a necessary step to allow for the testing.

Our program focuses on the types of PGT that can diagnose specific inherited conditions caused by a single-gene (PGT-M) or structural changes of a parent’s chromosome (PGT-SR) that could result in a significant health problem or severe disability. 

This new benefit will be available after July 1, 2021, for members who are on a new plan or upon renewal of their existing plans after this date.

Questions?

Contact united_genetics@uhc.com.

How to submit prior authorization and notification

Learn how to check requirements, submit new authorizations / notifications, check status, and submit updates by registering for live event or using the Prior Authorization and Notification Interactive User Guide.

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