Maryland Medicaid: New prior authorization requirements for 2 types of NIPT

Applies to CPT® codes 81422 and 81479

To comply with state requirements, effective June 1, 2025, we’ll require prior authorization for 2 types of Non-Invasive Prenatal Testing (NIPT) for UnitedHealthcare Community Plan of Maryland members.

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, SCA and microdeletions

How to submit a request

You can submit a prior authorization request through the UnitedHealthcare Provider Portal:

• Go to UHCprovider.com and select Sign In at the top-right corner
• Sign in to the portal using your One Healthcare ID and password 
  • If you are a new user and don’t have a One Healthcare ID, visit the provider portal registration page to get started
• In 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
• Enter the required information and submit

If we don’t receive a prior authorization request before the date of service, we’ll deny the claim and you won’t be able to balance bill members.

Resources

• Maryland Department of Health Non-Invasive Prenatal Testing clinical criteria for coverage determination guidelines, documentation requirements and additional information
• Please visit our Prior Authorization and Notification Interactive User Guide

Questions?

If you have questions, please visit our Prior Authorization and Notification page.