Prenatal Genetic Testing and Counseling Therapy

Determination:

Molina Healthcare of New Mexico considers genetic counseling and invasive prenatal diagnosis by chorionic villus sampling (CVS), genetic amniocentesis, and percutaneous umbilical blood sampling (PUBS) (cordocentesis) medically necessary in pregnancies known to be at risk for specific, detectable, heritable disorders. The following are the most common medically necessary indications for invasive prenatal diagnosis:

• Advanced maternal age (age 35 years or more at estimated date of delivery for singleton pregnancy, age 33 years or more for multiple pregnancy) (Note: In cases of donor egg assisted reproduction, this age criterion applies to the age of the donor, not the recipient);
• Previous child with a chromosomal abnormality;
• Parental chromosomal rearrangement or aneuploidy;
• Positive maternal serum screening test (Multiple Marker Screening (MMS)), documenting increased risk of fetal neural tube defects (NTD) and/or fetal chromosome abnormality;
• Documented risk for detectable single gene (Mendelian)
• Abnormal fetal ultrasound examination (revealing signs proven to be associated with fetal aneuploidy);
• Previous child with NTD or known increased risk for NTD (CVS is not considered medically necessary for risk of NTD);
• Other suspected risk for a specific detectable fetal disorder.

References:

American College of Obstetrics and Gynecology Practice Bulletin Number 27, May 2001: Prenatal Diagnosis of fetal Chromosomal Abnormalities.

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