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Current Criteria for Publicly Funded Non-invasive Prenatal Testing (NIPT) in Ontario

    Current Criteria for Publicly Funded Non-invasive Prenatal Testing (NIPT) in Ontario

    The Ontario Health Insurance Plan (OHIP) will currently fund non-invasive prenatal testing (NIPT) for pregnant patients considered to be at high risk for trisomies 21, 18, 13 and sex chromosome aneuploidies under two categories.  At this time, NIPT for microdeletion syndromes is not covered.

    OHIP-funded NIPT for pregnant person’s in Category I can be ordered by any physician, while requests for OHIP-funding for individuals in Category II must be ordered by a geneticist or maternal–fetal medicine specialist.

    Category I (can be ordered by any physician)

    o Maternal age ≥ 40 years at time of delivery

    o Positive maternal serum screen result

    o Nuchal translucency ≥ 3.5 mm on ultrasound

    o Previous pregnancy with a chromosome anomaly

     

    Category II (must be ordered by a genetics or maternal–fetal medicine specialist)

    o Fetal congenital anomalies identified on ultrasound that are suggestive of trisomy 21, 18, or 13

    o Risk of aneuploidy for trisomies 21, 18, and 13 other than positive maternal multiple marker screen

    ▪ If maternal age is < 40 years at expected date of delivery, must have at least one other risk factor noted
    ▪ Risk of aneuploidy can be calculated by including any combination of risk indicators, including soft markers, biochemistry, maternal age, etc.

    o NIPT for sex chromosome determination for at least one of the following:

    ▪ Risk of sex-limited disorder
    ▪ Ultrasound findings suggestive of a sex chromosome aneuploidy
    ▪ Ultrasound findings suggestive of a disorder of sex determination