| Chromosomal Microarray AHS – M2033 "Notification" |
Reviewed by Avalon 2nd Quarter 2021 CAB. Medical Director review 7/2021. Under Billing/Coding section, added PLA code 0252U, deleted 0209U. Updated Policy Guidelines and References. Under “When Covered” section, added “for evaluation of 2nd consecutive clinical first trimester pregnancy loss” to statement #2. Under “When Covered” section for statement #3 also added: “When fetal growth restriction is detected and a fetal malformation, polyhydramnios, or both are also present regardless of gestational age, OR for item F and “When unexplained isolated fetal growth restriction is diagnosed at <32 weeks of gestation, OR” for item G. Notification given 8/24/21 for effective date 11/2/21. |
Blue Connect