StartingJuly 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:
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.