Maryland Medicaid Introduces New Prior Authorization Requirements for Two NIPT Tests
Maryland Medicaid Introduces New Prior Authorization Requirements for Two NIPT Tests
Applies to CPT (Current Procedural Terminology) Codes 81422 and 81479
Starting June 01, 2025, UnitedHealthcare Community Plan of Maryland will require prior authorization for two types of Non-Invasive Prenatal Testing (NIPT) to comply with state requirements.
This change applies to CPT codes 81422 and 81479 when used for the following procedures:
- NIPT for trisomy screening and sex chromosomal analysis
- NIPT for trisomy screening, sex chromosomal analysis (SCA), and microdeletions
How to Submit a Prior Authorization Request
Prior authorization requests can be submitted through the UnitedHealthcare Provider Portal by following these steps:
- Go to UHCprovider.com and select Sign In at the top right corner
- Log in using your One Healthcare ID and password
- If you are a new user and do not have a One Healthcare ID, visit the provider portal registration page to get started
- From the menu, select Prior Authorizations
- In the Prior Authorization and Notification tool, scroll down to "Create a new notification or prior authorization request" and click Create New Submissions
- Fill in the required information and submit
If a prior authorization request is not submitted before the date of service, the claim will be denied, and you will not be able to balance bill the member.
Resources
- Maryland Department of Health Non-Invasive Prenatal Testing clinical criteria for coverage determination guidelines, documentation requirements, and additional information
- Prior Authorization and Notification Interactive User Guide
Questions?
For any questions, visit our Prior Authorization and Notification page.
