Measuring fetal nuchal translucency thickness (codes 76813, 76814) is a prenatal genetic testing procedure that is typically performed after the first trimester of pregnancy as an option to assess the risk of having a child with a number of chromosomal abnormalities and congenital defects, such as, but not limited to Down Syndrome (trisomy 21), Edwards Syndrome (trisomy 18), Turner Syndrome (monosomy X), and congenital conditions particularly of cardiac origin. Fetal nuchal translucency testing in the first trimester is eligible when performed in conjunction with maternal serum markers quantitative human chorionic gonadotropin (codes 84702/84704) and pregnancy-associated plasma protein-A (PAPP-A)(code 84163). The FNT ultrasound imaging and the maternal serum markers may not necessarily be performed on the same day or by the same provider. In these cases, the FNT study in the first trimester is eligible when performed in conjunction with and no longer than 7 days before or after the maternal serum markers. The patient should be adequately counseled prior to the procedure. 

Fetal nuchal translucency testing performed alone in the first trimester is considered experimental/investigational for all uses. The technique for measuring nuchal translucency and the criteria for defining increased nuchal translucency as the sole method of testing has not yet been standardized in the clinical setting. Additional short and long term studies involving larger numbers of patients are necessary to confirm the efficacy of first trimester nuchal translucency without serum markers before this modality can be accepted for routine clinical use.

A participating, preferred, or network provider can bill the member for services denied as experimental/investigational. 

Description

All fetuses have a layer of fluid on the back of the bodies between the skin and the underlying soft tissue. Babies with chromosomal and heart defects tend to have more fluid in this layer. This layer is translucent on ultrasound, and its thickness is measured at the level of the neck. 

Measuring fetal nuchal translucency thickness is an ultrasonic prenatal genetic testing procedure used to detect subcutaneous edema in the fetal neck. The fluid is measured between the inner aspect of the fetal skin and the outer aspect of soft tissue overlying the cervical spine or the occipital bone. Increased fetal nuchal translucency has been associated with chromosomal defects, most commonly Down syndrome, and other genetic syndromes, as well as abnormalities of the heart and great arteries, and a wide range of skeletal dysplasias.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

02/2004, Fetal nuchal translucency considered experimental/investigational
02/2006, Coverage for fetal nuchal translucency revised

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