NIPT Funding Criteria

Category I criteria (can be ordered by any physician, midwife or nurse practitioner)

• A multiple marker screening test (e.g. eFTS/STS) positive for aneuploidy
• The age of the pregnant individual will be 40 years or older at the expected date of delivery
  
  • In the context of in vitro fertilization, this is defined as the oocyte (egg) age at retrieval being 39 or older (whether self-provided or donor oocyte)
• Previous pregnancy or child with trisomy 21, 18 or 13
• Twin pregnancy with ultrasound demonstration of fetal heart activity in both fetuses
• Increased nuchal translucency (NT) measurement (≥3.5mm)
  • *NT ≥3.5mm can be associated with genetic conditions and fetal congenital anomalies not detected by NIPT. Prompt referral to a Genetics / Maternal Fetal Medicine (MFM) specialist is indicated regardless of NIPT order or result.

If you meet one of these requirements, your health-care provider can use the publicly-funded requisition for testing. 

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

Risk indicators for trisomy 21, trisomy 18, trisomy 13 (select all that apply):

• Fetal congenital anomalies identified on ultrasound, which are suggestive of trisomy 21, 18 or 13
• Cystic hygroma
• Isolated soft marker with moderate likelihood ratio for trisomy 21 (one or more):
  • Increased nuchal fold (≥ 6mm)
  • Absent/Hypoplastic nasal bone
• Multiple soft markers with low likelihood ratio for trisomy 21 (two or more):
  • Aberrant right subclavian artery
  • lntracardiac echogenic focus/foci
  • Short humerus
  • Clinodactyly
  • Pyelectasis
  • Ventriculomegaly
  • Hyperechogenic bowel
  • Short femur

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

• Risk of a sex-linked condition
• Ultrasound findings suggestive of a sex chromosome aneuploidy
• Ultrasound findings suggestive of a difference/disorder of sex development (DSD)

If you meet one of these requirements, your health-care provider can use the publicly-funded requisition for testing.

You can choose to pay for private-pay NIPT if you do not meet any of the criteria. This means that you would pay for this testing yourself, or you may get it covered through your private health insurance.

If you have not had any screening in your pregnancy, you can consider starting with an publicly-funded prenatal screening test (eFTS or STS) before deciding to pay out-of-pocket for NIPT. A "screen positive" result from one of these other tests would make it possible for you to have publicly-funded NIPT. 

Take note that if you are paying for NIPT out-of-pocket, and later in the pregnancy you meet one of the funding criteria, you will not be able to get a refund.

In Ontario, private-pay NIPT is available through the Ontario-based laboratories (LifeLabs or Dynacare), as well as through other laboratories based outside of Canada (blood samples and personal health information is sent out of the country, where the testing is performed).

Prenatal Screening Ontario is unable to endorse any specific private-pay test or laboratory. If you are interested in pursuing private-pay NIPT, please talk to your health-care practitioner about which test might be best for you.

Here are some questions you or your provider can ask if you are thinking to have private-pay NIPT:

• Does the laboratory have information available on how well the test performs for each of the screened chromosome differences? Has this information been published in a trusted scientific journal where it was reviewed by other experts?
• What is the process for ordering NIPT at the laboratory? Can the blood draw be done in your area?
• Can the testing be limited to trisomy 21, trisomy 18, trisomy 13 and sex chromosome differences? Canadian and international guidelines do not currently support the use of NIPT to screen for other conditions because the accuracy is less well known.
• What is the cost of NIPT?
• Is genetic counselling available by the NIPT testing company before and/or after you have NIPT to help you understand the test and results?
• If the testing is performed outside of Canada, how does the out-of-country laboratory manage and protect your personal health information?