Provider Alert! Cystic Fibrosis and Spinal Muscular Atrophy Screening Authorization No Longer Required

Provider Alert!

Provider Alert! Cystic Fibrosis and Spinal Muscular Atrophy Screening Authorization No Longer Required

Date: May 27, 2021

Attention: Obstetric Care Providers

Effective Date: June 1, 2021

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan (TCHP) would like to inform network providers that beginning June 1, 2021; a prior authorization is no longer required for the following genetic screenings:

  • Spinal Muscular Atrophy screening, SMA 81329
  • Cystic Fibrosis screening, CF 81220

Resources:

  • Prenatal carrier screening for pregnant women recommended by the American College of Obstetricians and Gynecologists for Spinal Muscular Atrophy and Cystic Fibrosis

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/03/carrier-screening-for-genetic-conditions

  • Texas State Newborn screening includes Cystic Fibrosis

Spinal Muscular Atrophy will be added 6/1/21

https://www.dshs.texas.gov/newborn/default.shtm

How this impacts providers: Benefit is a once per lifetime max. As a reminder, TCHP utilizes Quest Diagnostics as our exclusive reference lab provider. Providers must refer members for this screening to Quest Diagnostics.

Next steps for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers

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