Find policies, billing codes, payers, states, and providers

CPT 0494U: Natera Rh Test, Fetal RhD Status by Cell‑Free DNA

CPT code 0494U designates a Proprietary Laboratory Analyses (PLA) test: Natera’s Rh Test, which uses next‑generation sequencing of cell‑free fetal DNA from maternal blood to determine fetal RhD status in RhD‑negative pregnant individuals. As a PLA code tied to a single manufacturer's assay, this code informs coverage and billing for a precision perinatal diagnostic that can influence antenatal management and resource utilization nationwide. Key national payers addressed include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical purpose of the test, the service and site of service context, and what payers typically consider when evaluating coverage for proprietary prenatal cell‑free DNA assays. The publication summarizes payer inclusion in the analysis, available benchmark considerations, and relevant policy or coverage updates where present. It also outlines clinical context for use in RhD‑negative pregnancies and highlights where input or data were not provided. Data not available in the input are noted as such rather than inferred.

Customize your policy alerts

Sign up for cpt 0494U policy alerts

Get alerted when payer policies referencing 0494U are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

CPT code 0494U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to a single, manufacturer‑specific test: the Rh Test from Natera™. The assay uses next‑generation sequencing to analyze cell‑free DNA in the blood of RhD‑negative pregnant individuals to determine whether the fetus has inherited the RhD gene.

Service type: Laboratory molecular diagnostic testing using next‑generation sequencing of cell‑free fetal DNA
Typical site of service: Clinical laboratory or outpatient phlebotomy site; specimen collection occurs in outpatient clinic or laboratory collection settings

Explore openpayer tools

View all tools

Find policies, billing codes, payers, states, and providers

CPT 0494U: Natera Rh Test, Fetal RhD Status by Cell‑Free DNA

Customize your policy alerts

Sign up for cpt 0494U policy alerts

Get alerted when payer policies referencing 0494U are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Laboratory molecular diagnostic testing using next‑generation sequencing of cell‑free fetal DNA
Typical site of service: Clinical laboratory or outpatient phlebotomy site; specimen collection occurs in outpatient clinic or laboratory collection settings

Clinical & Coding Specifications

Clinical Context

A pregnant individual with RhD-negative blood type presents for prenatal care. Routine maternal blood typing identifies RhD negativity; the ordering clinician requests noninvasive fetal RhD genotyping to determine fetal RhD status and guide antenatal and peripartum management. A phlebotomy encounter occurs in an outpatient obstetrics clinic, prenatal diagnostic center, or affiliated laboratory collection site. A maternal blood sample is sent to the proprietary Natera™ assay using next-generation sequencing of cell-free fetal DNA to detect fetal RhD gene sequences. Results are reported to the ordering obstetrician or maternal-fetal medicine specialist and used to determine need for antenatal anti-D (Rho(D) immune globulin) administration, peripartum management, and postpartum neonatal evaluation.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use when no specific modifier applies; default reporting for the PLA test.
`26`	Professional component	Use if provider bills for interpretation or professional component separately from the laboratory technical component.
`TC`	Technical component	Use when billing only the laboratory technical component (processing and analysis) and the performing lab retains the professional component.
`QX`	Ordering physician certified and performing non-physician practitioner (modifier)	Use when applicable compliance requires distinguishing services performed by a non-physician practitioner under a billing physician.
`QY`	Ordering professional is a laboratory director performing test oversight	Use when the laboratory director furnishes and bills professional oversight distinct from technical services.
`QK`	Complex laboratory test — advanced genotyping (payment modifier)	Use only if payer-specific policies require a PLA-level lab test modifier indicating complex molecular analysis.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when a PA/NP/CNS orders or directly provides associated patient-facing services and payer requires modifier reporting.
`52`	Reduced services	Use when an abbreviated or partial test was performed and payer requires documentation of reduced service.
`53`	Discontinued procedure	Use if specimen collection or testing was discontinued for clinical reasons after initiation.
`78`	Unplanned return to operating/procedure room	Not typically used for laboratory testing; included for completeness—use only if testing was part of an intraoperative series requiring an unplanned return.
`62`	Two surgeons	Not routinely applicable to laboratory testing; use only if procedural billing with multiple surgeons applies to related services.

Taxonomy Code	Specialty	Notes
207Q00000X	Obstetrics & Gynecology	Ordering providers commonly include obstetricians managing prenatal care.
207K00000X	Maternal-Fetal Medicine	Specialists order and interpret invasive and noninvasive prenatal testing for high-risk pregnancies.
207P00000X	Nurse Midwife	Midwives involved in prenatal care may order noninvasive fetal RhD testing per protocols.
261QM0800X	Clinical Molecular Genetics Laboratory	Performing laboratory specialty responsible for next-generation sequencing assays.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O36.0120`	Maternal care for Rh sensitization, first trimester, unspecified fetus	Indicates maternal Rh sensitization risk prompting fetal RhD genotyping decisions.
`O36.0121`	Maternal care for Rh sensitization, first trimester, fetus 1	Used when monitoring an identified sensitized pregnancy; fetal RhD status informs management.
`O36.0122`	Maternal care for Rh sensitization, first trimester, fetus 2	Multiple gestation coding when assessing fetal RhD in one of multiple fetuses.
`Z32.01`	Encounter for pregnancy test, result positive	Initial prenatal confirmation; often precedes ordering prenatal labs including RhD testing.
`Z34.90`	Encounter for supervision of normal pregnancy, unspecified, first trimester	Routine prenatal care encounter during which noninvasive fetal RhD testing may be ordered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Venipuncture for maternal blood specimen collection prior to sending sample for the Natera™ RhD assay.
`81025`	Urine pregnancy test, by visual color comparison methods	Performed in some prenatal workflows to confirm pregnancy when initial prenatal intake occurs, often before ordering prenatal labs.
`99406`	Smoking and tobacco cessation counseling, intermediate, 3–10 minutes	Example of prenatal counseling services that may be billed during the same prenatal visit when the specimen is collected (time-based E/M-adjunct service).
`76813`	Ultrasound, first trimester, transabdominal and transvaginal when performed	Prenatal ultrasound commonly ordered in parallel in prenatal care; not part of the lab test but part of overall prenatal assessment.
`86316`	Antibody; Rh (D) (assay) — immunoassay	Serologic Rh antibody testing often performed in prenatal panels alongside noninvasive fetal RhD genotyping to assess maternal alloimmunization.

CPT 0001U: PreciseType HEA Multiplex Erythrocyte Antigen Assay

CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

CPT 0002U: Urine Metabolomic Polyp Risk Assay (PolypDX™)

CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

CPT 0003U: Overa™ (OVA1 Next Generation) Ovarian Cancer Risk Assay

CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

CPT 0005U: ExosomeDx Prostate (IntelliScore) Urine Gene Expression Risk Test

CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

CPT 0007U: ToxProtect Urine Drug Screen with DNA Authentication

CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

CPT 0008U: H. pylori Antibiotic Resistance Panel, Gene Sequence Analysis

CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

CPT 0011U: Cordant CORE™ Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcript Testing

Showing 1–10 of 536

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use when no specific modifier applies; default reporting for the PLA test.
`26`	Professional component	Use if provider bills for interpretation or professional component separately from the laboratory technical component.
`TC`	Technical component	Use when billing only the laboratory technical component (processing and analysis) and the performing lab retains the professional component.
`QX`	Ordering physician certified and performing non-physician practitioner (modifier)	Use when applicable compliance requires distinguishing services performed by a non-physician practitioner under a billing physician.
`QY`	Ordering professional is a laboratory director performing test oversight	Use when the laboratory director furnishes and bills professional oversight distinct from technical services.
`QK`	Complex laboratory test — advanced genotyping (payment modifier)	Use only if payer-specific policies require a PLA-level lab test modifier indicating complex molecular analysis.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when a PA/NP/CNS orders or directly provides associated patient-facing services and payer requires modifier reporting.
`52`	Reduced services	Use when an abbreviated or partial test was performed and payer requires documentation of reduced service.
`53`	Discontinued procedure	Use if specimen collection or testing was discontinued for clinical reasons after initiation.
`78`	Unplanned return to operating/procedure room	Not typically used for laboratory testing; included for completeness—use only if testing was part of an intraoperative series requiring an unplanned return.
`62`	Two surgeons	Not routinely applicable to laboratory testing; use only if procedural billing with multiple surgeons applies to related services.

Taxonomy Code	Specialty	Notes
207Q00000X	Obstetrics & Gynecology	Ordering providers commonly include obstetricians managing prenatal care.
207K00000X	Maternal-Fetal Medicine	Specialists order and interpret invasive and noninvasive prenatal testing for high-risk pregnancies.
207P00000X	Nurse Midwife	Midwives involved in prenatal care may order noninvasive fetal RhD testing per protocols.
261QM0800X	Clinical Molecular Genetics Laboratory	Performing laboratory specialty responsible for next-generation sequencing assays.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O36.0120`	Maternal care for Rh sensitization, first trimester, unspecified fetus	Indicates maternal Rh sensitization risk prompting fetal RhD genotyping decisions.
`O36.0121`	Maternal care for Rh sensitization, first trimester, fetus 1	Used when monitoring an identified sensitized pregnancy; fetal RhD status informs management.
`O36.0122`	Maternal care for Rh sensitization, first trimester, fetus 2	Multiple gestation coding when assessing fetal RhD in one of multiple fetuses.
`Z32.01`	Encounter for pregnancy test, result positive	Initial prenatal confirmation; often precedes ordering prenatal labs including RhD testing.
`Z34.90`	Encounter for supervision of normal pregnancy, unspecified, first trimester	Routine prenatal care encounter during which noninvasive fetal RhD testing may be ordered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Venipuncture for maternal blood specimen collection prior to sending sample for the Natera™ RhD assay.
`81025`	Urine pregnancy test, by visual color comparison methods	Performed in some prenatal workflows to confirm pregnancy when initial prenatal intake occurs, often before ordering prenatal labs.
`99406`	Smoking and tobacco cessation counseling, intermediate, 3–10 minutes	Example of prenatal counseling services that may be billed during the same prenatal visit when the specimen is collected (time-based E/M-adjunct service).
`76813`	Ultrasound, first trimester, transabdominal and transvaginal when performed	Prenatal ultrasound commonly ordered in parallel in prenatal care; not part of the lab test but part of overall prenatal assessment.
`86316`	Antibody; Rh (D) (assay) — immunoassay	Serologic Rh antibody testing often performed in prenatal panels alongside noninvasive fetal RhD genotyping to assess maternal alloimmunization.

CPT 0001U: PreciseType HEA Multiplex Erythrocyte Antigen Assay

CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

CPT 0002U: Urine Metabolomic Polyp Risk Assay (PolypDX™)

CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

CPT 0003U: Overa™ (OVA1 Next Generation) Ovarian Cancer Risk Assay

CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

CPT 0005U: ExosomeDx Prostate (IntelliScore) Urine Gene Expression Risk Test

CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

CPT 0007U: ToxProtect Urine Drug Screen with DNA Authentication

CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

CPT 0008U: H. pylori Antibiotic Resistance Panel, Gene Sequence Analysis

CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

CPT 0011U: Cordant CORE™ Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcript Testing

Showing 1–10 of 536

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 0494U: Natera Rh Test, Fetal RhD Status by Cell‑Free DNA

Sign up for cpt 0494U policy alerts

Billing Code Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

CPT 0494U: Natera Rh Test, Fetal RhD Status by Cell‑Free DNA

Sign up for cpt 0494U policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 0494U: Natera Rh Test, Fetal RhD Status by Cell‑Free DNA

Sign up for cpt 0494U policy alerts

Billing Code Overview

CPT 0494U: Natera Rh Test, Fetal RhD Status by Cell‑Free DNA

Sign up for cpt 0494U policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 0494U represent?

Where and how is the sample for 0494U usually collected?

Which modifiers are relevant when billing CPT 0494U?

What other CPT codes or services are commonly associated with this test in prenatal care?

Which payers are referenced for coverage and does the page state reimbursement rates or coverage decisions?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 0494U represent?

Where and how is the sample for 0494U usually collected?

Which modifiers are relevant when billing CPT 0494U?

What other CPT codes or services are commonly associated with this test in prenatal care?

Which payers are referenced for coverage and does the page state reimbursement rates or coverage decisions?

References