Does Q99.9 require prior authorization?

No, Q99.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Q99.9`, Chromosomal abnormality, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation (and counseling) that traditional diagnostic testing or screening for aneuploidy should be offered to all patients who have had PGT-A: "Traditional diagnostic testing or screening for aneuploidy should be offered to all patients who have had PGT-A..." (ACOG 2020).
Evidence of informed consent and counseling regarding limitations, accuracy, and need for confirmatory invasive testing for chromosomal abnormalities (explicit in ACOG, ASRM and other society statements in the document).
When PCR-based single-cell testing is performed, use of ICSI is recommended to avoid contamination; documentation of insemination method may be required where PCR-based PGT-M is used: "for carriers of single gene disorders where PCR will be applied... ICSI is recommended to avoid cellular DNA from non-fertilizing sperm." (PGDIS / ESHRE guidance cited).

PGT-M / PGD is medically necessary when the genetic disease is associated with clinically significant morbidity or disability.
Invasive prenatal diagnosis by chorionic villus sampling (CVS), genetic amniocentesis, and percutaneous umbilical blood sampling (PUBS / cordocentesis) for diagnosis of fetal chromosomal abnormalities.
Preimplantation genetic testing for monogenic disorders (PGT-M / formerly PGD) on single cells is medically necessary when ALL of the PGT-M criteria in this policy are met (see below).
PGT-M / PGD is medically necessary to diagnose an autosomal dominant condition when at least one parent is a known carrier.
PGT-M / PGD is medically necessary to diagnose an autosomal recessive condition when both parents are known carriers (example: cystic fibrosis when parents are known mutation carriers).
PGT-M / PGD is medically necessary to diagnose an X-linked condition when at least one parent is a known carrier (example: hemophilia).

AETNA-CPB-0282, Noninvasive Down Syndrome Screening

AETNA-CPB-0358, Invasive Prenatal Diagnosis of Genetic Diseases

Ask Backwork about documentation requirements, denial risks, or coverage in your state.