SLIDE 1
Who has access to coverage for NIPS testing?
1
But this coverage can depend on a woman’s age.
Close to 90%
- f Medicaid
covered lives have some access to NIPS
2
for NIPS testing? 1 Close to 90% of Medicaid But this coverage - - PowerPoint PPT Presentation
for NIPS testing? 1 Close to 90% of Medicaid But this coverage - - PowerPoint PPT Presentation
Who has access to coverage for NIPS testing? 1 Close to 90% of Medicaid But this coverage covered lives can depend on a womans age. have some access to NIPS 2 State Medicaid Programs that Cover All Risk Florida, Pennsylvania,
SLIDE 2
SLIDE 3
State Medicaid Programs that Cover “All Risk”
3
Florida, Pennsylvania, Minnesota, Ohio and Virginia cover NIPS for all women -- regardless of their age or risk.
SLIDE 4
State Medicaid Programs that Cover “High Risk”
4
35 states provide access to NIPS only for high risk
Alaska Arkansas California Colorado Connecticut Delaware Georgia Hawaii Illinois Iowa Kansas Kentucky Maryland Massachusetts Michigan Mississippi Montana New Hampshire New Jersey North Carolina Oklahoma Oregon South Carolina South Dakota Tennessee Texas Utah Vermont Washington West Virginia Wisconsin
NIPS is limited to pregnant women who:
- Are over the age of 35
- History of a prior pregnancy with a
trisomy
- Fetal ultrasound finding show
increased risk of aneuploidy
- Positive first or second-trimester
standard biomarker screening test
SLIDE 5
Medicaid Managed Care plans also vary in their coverage of NIPS for all women.
However, if a Medicaid fee- for-service program covers a particular service, MCOS are legally obligated to cover that same service with no additional criteria.
5
SLIDE 6
Many major commercial insurance plans cover NIPS
6
SLIDE 7
Blue Cross Blue Shield Plans Covering Average Risk
- BCBS Arkansas
- BCBS Arizona
- BS California
- BCBS/Care First Maryland
- BCBS Connecticut
- BCBS Florida
- BCBS Empire (New York)
- BCBS Excellus (Central New
York)
- BCBS Georgia
- BlueCross Idaho
- BCBS/Anthem Indiana
- BCBS Kansas
- BCBS/Anthem Kentucky
- BCBS/Anthem Maine
- BCBS Massachusetts
- BCBS Michigan
- BCBS Mississippi
- BCBS/Anthem Missouri
- BCBS Nebraska
- BCBS Nevada
- BCBS New Hampshire
- BCBS New Jersey
- BCBS/Anthem Ohio
7
- BCBS/Anthem Ohio
- BCBS Rhode Island
- BCBS South Carolina
- BCBS Tennessee
- BCBS/Anthem Virginia
- BCBS/Anthem Wisconsin
- BCBS Wyoming
- BCBS North Carolina BCBS
- f North Dakota
- Capital Blue
- Premera Washington
- Regence Washington
SLIDE 8
What does NIPS coverage in Washington state look like?
8
SLIDE 9
9
Washington State Coverage Commercial
These insurance companies cover NIPS for all women in Washington State
SLIDE 10
10
Washington State Coverage Commercial
This insurance company covers NIPS
- nly for high risk
women
SLIDE 11
11
Washington State Coverage Medicaid
Washington State Medicaid Fee-for-Service only covers NIPS for high risk women.
Source: Kaiser Family Foundation “Births Financed by Medicaid”: https://www.kff.org/medicaid/state- indicator/births-financed-by-medicaid/
49%
Washington births financed by Medicaid
SLIDE 12
12
Washington State Coverage Medicaid
Managed Care Organizations
Covers NIPS for all women: Covers NIPS for high risk women:
SLIDE 13
13
Coverage Disparities
SLIDE 14
14
Standard Serum Screening
- 84702: Chorionic
gonadotropin test
- 84163: PAPPA serum
- 86336: Inhibin A
- 76813: 1st trimester nuchal
translucency ultrasound
CPT Codes
NIPS
- 81420
- 81507
Amnio
- 59000
CVS
- 59015