CPT 0247U: PreTRM® Maternal Serum Biomarker Risk Score for Spontaneous Preterm Birth - OpenPayer

Beta

OpenPayer Beta

Summary & Overview

CPT 0247U: PreTRM® Maternal Serum Biomarker Risk Score for Spontaneous Preterm Birth

CPT code 0247U identifies the PreTRM® Proprietary Laboratory Analysis from Sera Prognostics, Inc., a serum-based prenatal test that quantifies IBP4 and SHBG by LC–MS/MS and applies an algorithm to produce a risk score for spontaneous preterm birth. As a PLA code, 0247U is specific to a single manufacturer's assay and is used nationally to standardize reporting for this commercially available test. Its importance lies in informing prenatal risk stratification and potential care planning for pregnant patients at risk of spontaneous preterm delivery.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical purpose and laboratory service model, comparisons of payer coverage stances and benchmark utilization where available, and notes on coding and billing practice considerations for a proprietary assay. The publication presents national context on how payers treat PLA codes, summarizes typical sites of service and procedural workflow, and highlights implications for laboratory reporting and payer documentation requirements. Data not available in the input are explicitly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0247UCPTProprietary Laboratory AnalysisPreTRMprenatal screeningbiomarker assayLC-MS/MSpreterm birth riskmaternal serum test

Billing Code Overview

CPT code 0247U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to the PreTRM® test from Sera Prognostics, Inc. The test measures levels of insulin–like growth factor–binding protein 4 (IBP4) and sex hormone–binding globulin (SHBG) in maternal serum using liquid chromatography–tandem mass spectrometry (LC–MS/MS). An algorithmic analysis of those biomarker results produces a risk stratification score for spontaneous preterm birth.

Service type: Proprietary prenatal serum biomarker assay with algorithmic risk calculation
Typical site of service: Clinical laboratory (specimen collected in outpatient prenatal care settings and analyzed in a specialized reference laboratory)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A pregnant patient between 19 0/7 and 20 6/7 weeks gestation undergoes maternal serum testing using the PreTRM® assay (0247U). The typical workflow begins during a routine prenatal visit or maternal risk assessment when the obstetric clinician identifies a need to stratify risk for spontaneous preterm birth. A phlebotomy draw is performed in an outpatient obstetrics clinic or affiliated laboratory and the serum specimen is sent to the performing laboratory for LC–MS/MS measurement of insulin–like growth factor–binding protein 4 (IBP4) and sex hormone–binding globulin (SHBG). The laboratory runs the targeted assays, applies the proprietary algorithm to derive the PreTRM® risk score, and reports a risk stratification result to the ordering clinician. The clinician reviews the result in the context of the patient’s history, prior obstetric events, and current pregnancy risk factors and documents counseling and any subsequent management plan in the prenatal record.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/invalid in many payer systems; legacy code	Rarely used; follow payer-specific guidance if required as default
`22`

Taxonomy Code	Specialty	Notes
`207Q00000X`	Maternal and Fetal Medicine Physician	Specialists who may order the test for high-risk pregnancies
`207L00000X`	Obstetrics & Gynecology	Most common ordering specialty for prenatal risk assessment
`307QH0001X`	Clinical Laboratory Director	Laboratory leadership responsible for test oversight and reporting
`364S00000X`	Diagnostic Molecular Pathology	Labs or specialists involved in complex assay development and LC–MS/MS oversight

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O09.512`	Supervision of pregnancy with other poor reproductive or obstetric history, second trimester	Used when prior obstetric history increases concern for preterm birth and risk stratification is needed
`O09.513`	Supervision of pregnancy with other poor reproductive or obstetric history, third trimester	Applied when ongoing high-risk surveillance continues later in pregnancy
`O60.10`	Preterm labor without delivery, unspecified trimester	Relevant if clinician is assessing risk of spontaneous preterm birth or evaluating early labor risk
`O09.511`	Supervision of pregnancy with other poor reproductive or obstetric history, first trimester	May be used in high-risk pregnancies where early planning includes later risk stratification
`Z34.90`	Encounter for supervision of normal pregnancy, unspecified, unspecified trimester	Used for routine prenatal care when risk assessment testing is ordered as part of standard surveillance

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80055`	Obstetric panel (includes multiple analytes such as Hgb, blood type, rubella, syphilis, etc.)	Often ordered during the same prenatal visit; provides complementary baseline maternal laboratory data
`36415`	Collection of venous blood by venipuncture	Phlebotomy code used for the blood draw that provides the serum specimen for the PreTRM® assay
`83036`	Hemoglobin; glycosylated (A1C)	Occasionally ordered in pregnancy evaluations with metabolic concerns; may be on same lab requisition though not directly related to PreTRM®
`0001U`	An example PLA code (placeholder)	Other Proprietary Laboratory Analyses codes may be billed alongside when multiple commercial assays are performed; check payer rules for bundling