Maryland Medicaid Now Requires Prior Auth for Select NIPT Tests
Applies to CPT® codes 81422 and 81479
To meet state requirements, starting June 1, 2025, UnitedHealthcare Community Plan of Maryland requires prior authorization for two types of Non-Invasive Prenatal Testing (NIPT) for its members. This applies to CPT codes 81422 and 81479 when used for:
- NIPT for trisomy screening and sex chromosomal analysis.
- NIPT for trisomy screening, sex chromosomal analysis, and microdeletions.
How to Submit a Request
- Visit UHCprovider.com and click “Sign In” at the top-right corner.
- Log in with a One Healthcare ID and password.
- For new users without a One Healthcare ID, register on the provider portal registration page.
- From the menu, select “Prior Authorizations.”
- In the Prior Authorization and Notification tool, scroll to “Create a new notification or prior authorization request” and click “Create New Submissions.”
- Enter the required information and submit the request.
If UnitedHealthcare does not receive a prior authorization request before the service date, it will deny the claim, and the provider cannot balance bill members.
Resources
- The Maryland Department of Health Non-Invasive Prenatal Testing clinical criteria provide coverage determination guidelines, documentation requirements, and additional details.
- Providers can refer to the Prior Authorization and Notification Interactive User Guide for further assistance.
Questions?
For any questions, providers should visit the Prior Authorization and Notification page.
