Noninvasive Down Syndrome Screening — CPB 0282 | AETNA Coverage Update

Aetna modified CPB 0282 for noninvasive Down syndrome and fetal aneuploidy screening, effective September 26, 2025. Here's what billing teams need to act on now.

Aetna, a CVS Health company, updated CPB 0282 to clarify when first-trimester nuchal translucency ultrasound and serum analyte screening are — and aren't — covered. The change has direct implications for CPT codes 76813 and 76814 in particular. If your practice bills prenatal screening for Aetna members, this coverage policy affects your charge capture, your claim denial exposure, and your medical necessity documentation.

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Quick-Reference: Aetna CPB 0282 Noninvasive Down Syndrome Screening (2025)

Field	Detail
Payer	Aetna, a CVS Health company
Policy	Noninvasive Down Syndrome Screening
Policy Code	CPB 0282
Change Type	Modified
Effective Date	September 26, 2025
Impact Level	High
Specialties Affected	OB/GYN, Maternal-Fetal Medicine, Laboratory, Radiology
Key Action	Stop billing CPT 76813/76814 for NT measurement when the patient already has negative cfDNA/NIPT results in the current pregnancy

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Aetna Noninvasive Fetal Aneuploidy Screening Coverage Criteria and Medical Necessity Requirements 2025

The Aetna Down syndrome screening coverage policy recognizes six pathways to medical necessity for fetal aneuploidy screening. Each is distinct. Billing the wrong pathway — or stacking tests that fall outside one pathway — will get your claim denied.

Here's what Aetna covers under CPB 0282 in the CPB 0282 Aetna system:

Pathway 1: First-trimester NT alone (multiple gestations). Aetna covers nuchal translucency ultrasound — billed as CPT 76813 for the primary fetus and add-on code 76814 for each additional gestation — without serum analytes when the patient is carrying multiples.

Pathway 2: First-trimester combined screen. NT measurement (76813/76814) plus serum analytes — pregnancy-associated plasma protein A (PAPP-A, billed as CPT 84163) and beta-hCG (CPT 84702 or 84704 depending on method). Aetna treats free beta subunit of hCG, total hCG, and hyperglycosylated hCG (invasive trophoblast antigen) as interchangeable for this policy.

Pathway 3: Integrated, sequential, or contingent screening. This is the most code-intensive pathway. It combines first-trimester triple test (NT plus PAPP-A plus hCG) with a second-trimester quadruple screen — maternal serum alpha-fetoprotein (MSAFP, CPT 82105), unconjugated estriol (CPT 82677), inhibin A (CPT 86336), and hCG. Panel codes 81509 through 81512 apply here depending on which analytes are ordered. Reimbursement for this pathway requires documentation supporting the sequential or contingent screening decision.

Pathway 4: Second-trimester serum analyte screening only. Aetna defers to CPB 0464 for the full criteria here.

Pathway 5: Serum integrated screening (when NT is unavailable). If NT measurement can't be obtained — provider not available, patient can't tolerate the exam, gestational age outside the window — Aetna covers first-trimester PAPP-A plus hCG combined with second-trimester quad screening. Document why NT was unobtainable. Without that documentation, expect a medical necessity denial.

Pathway 6: Cell-free fetal DNA (cfDNA/NIPT). Covered when criteria in CPB 0464 are met. This is billed under CPT 81420 or 81507 depending on the test type.

The prior authorization requirements for these pathways follow Aetna's standard prenatal screening rules. Check current plan-level requirements before assuming routine screening is exempt from prior auth.

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Aetna Noninvasive Down Syndrome Screening Exclusions and Non-Covered Indications

This is where the September 26, 2025 update has the most teeth.

No stacking with NIPT/cfDNA. Aetna considers all the screening pathways listed above — NT ultrasound, serum analytes, integrated screens, the whole list — not medically necessary if the patient has already had or is currently having microarray or NIPT with cell-free DNA in the same pregnancy. One or the other. Not both.

NT ultrasound after negative cfDNA results. This is the sharpest new edge in this coverage policy. Aetna states directly: if a patient already has reassuring negative cfDNA results, a follow-up ultrasound at 10–14 weeks solely to measure nuchal translucency is not recommended and is not medically necessary. CPT 76813 and 76814 should not be billed in that scenario — even if the NT measurement is physically obtained during the visit.

That last clause is the one to flag for your billing team. The measurement can happen. The bill should not. This distinction is a common source of claim denial because the encounter looks billable on its face.

Circular RNA (circRNA) testing. CPT 83520 appears in this policy under the label "Maternal fetal-derived circular RNA (circRNAs), measurement." This test is not included in the covered pathways. Treat it as non-covered unless Aetna updates the policy.

Cross-reference this policy with CPB 0464 (Serum and Urine Marker Screening for Fetal Aneuploidy) and CPB 0787 (Comparative Genomic Hybridization) before billing any cell-free DNA or microarray codes on an Aetna prenatal claim.

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Coverage Indications at a Glance

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Aetna Fetal Aneuploidy Screening Billing Guidelines and Action Items 2025

The effective date is September 26, 2025. If you haven't already reviewed your charge capture for prenatal screening, do it now.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Noninvasive Down Syndrome Screening Under CPB 0282

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered / Non-Standard Codes Under This Policy

Code	Type	Description	Reason Copy
83520	CPT	Immunoassay, analyte quantitative; not otherwise specified [maternal fetal-derived circRNA measurement]	Not part of any covered screening pathway under CPB 0282

Key ICD-10-CM Diagnosis Codes

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