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Prenatal Care Provider FAQ

Frequently Asked Questions on the PNS Program

Program changes went into effect on September 19, 2022

NOTE: Kaiser providers should check with their internal systems to find out how ordering screening tests or result communications differs from what is summarized here.

Summary of Prenatal Screening Program Changes of 2022 (PDF, 2 pages)

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Post PNS Program launch

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PNS Program

On September 19, 2022, the California Prenatal Screening (PNS) Program launched its revised program. Cell-free DNA (cfDNA) is now the primary screening test for trisomy 21, trisomy 18, and trisomy 13, replacing biochemical screening for trisomies 21 and 18.

cfDNA screening is available starting at 10 weeks 0 days and can be done throughout pregnancy. However, the PNS Program recommends that cfDNA screening take place from 10 weeks 0 days through 21 weeks 0 days so that all follow-up services can be available to individuals determined to be high risk. cfDNA screening also gives patients the option to find out the sex of the fetus. Providers can choose this option by checking a box when ordering screening. There is no additional cost for finding out the fetal sex.

In addition to cfDNA, maternal serum alpha fetoprotein (MSAFP) screening for neural tube defects is still offered, now from 15 weeks 0 days through 21 weeks 0 days of gestational age. 

The PNS Program continue to provide follow-up genetic counseling and diagnostic services for participants with screen-positive results for the three trisomies or neural tube defects at state-approved Prenatal Diagnosis Centers.

Within the PNS Program, providers choose to work with one of the three state-contracted labs. They are Natera, Quest Diagnostics, and Revvity. They screen for trisomy 21, trisomy 18, and trisomy 13 and neural tube defects (what is on the state’s screening panel). The revised PNS Program screening panel does not currently include sex chromosome anomalies or microdeletions. See questions and answers below for more details on this.

Another change is the expanded use of the CalGenetic Portal for ordering screening and getting results. See questions and answers below for more details on this.

An additional change is regarding nuchal transluchency ultrasound. Nuchal translucency ultrasounds are still recommended as the most accurate dating method of gestational age. However, the PNS Program no longer requires a nuchal translucency measurement to receive a preliminary risk assessment for fetal chromosomal abnormalities with a first trimester biochemical screening test. The previous policy to authorize follow-up services at a state-contracted Prenatal Diagnosis Center with a large NT > 3.0 mm, regardless of the biochemical screening result, has ended. 

However, if the cfDNA or MSAFP screening result is positive, and the patient goes to a state-contracted Prenatal Diagnosis Center and the fetus is identified to have a large NT > 3.0 mm, and the patient chooses to have an amniocentesis, the patient can choose to have a karyotype or microarray.

Yes, patient can opt to have fetal sex reported. Clinicians should talk to their patient to find out if they want fetal sex disclosed. Depending on the patient’s decision, clinicians should select the appropriate checkbox when ordering a cfDNA screening test. There is no additional cost for fetal sex reporting.

Starting April 1, 2024, the CA PNS Program will add sex chromosome aneuploidies (SCAs)​, Turner syndrome, Klinefelter syndrome, Trisomy X and XYY. The revised PNS Program screening panel does not currently include sex chromosome anomalies (SCAs) or microdeletions. Providers can separately order these and other screenings, including carrier screenings, outside of the PNS Program screening panel. 

Yes. Certain of the three state-contracted laboratories will allow providers to order additional screening for sex chromosome anomalies or microdeletions using the same blood specimen taken from a patient through the revised PNS Program. 

Even though the same blood specimen may be used, the additional screening at the state-contracted laboratory will technically be independent of the revised PNS Program. It will require the creation of a separate test request process. The laboratory conducting those tests will bill separately for these services.

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CalGenetic Portal

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cfDNA screening 

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Both cfDNA and MSAFP screening 

Prenatal screening for twins will be provided through the revised PNS Program. Pregnancies with more than two fetuses are not eligible for prenatal screening through the revised PNS Program. SCA detection via cfDNA screening in the California PNS Program is only available for monozygotic twins. SCA screening is not available for multiple gestation of two (dizygotic twins) or more fetuses.​

Fetal reduction or fetal demise will make a patient ineligible for prenatal screening through the revised PNS Program. A list of all conditions that would make a patient ineligible for screening is provided on the CalGenetic Portal and is displayed when a provider begins the screening orders process.

Patient billing and payment

As of September 19, 2022, the PNS Program participation fees is $232 for cfDNA screening and $85 for MSAFP screening. The cfDNA screening fee will increase to $344 on July 1, 2024.​​ The PNS Program participation fee is for comprehensive screening and follow-up, meaning that if a patient has a positive screening result, the fee will cover all follow-up services including genetic counseling, ultrasound, and diagnostic testing.

Per state regulations, Medi-Cal and private insurance must cover all program fees, with only a few exceptions for self-insured employers and out-of-state health plans. Patients are directly billed if they do not have insurance or if their insurance is affected by these exception categories and won't cover fees.

PNS Program e​ducational materials

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