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    v1.0.30
    OpenPayerBilling CodesMultianalyte Assays with Algorithmic AnalysesCPT cpt-81506-diabetes-biomarker-panel-with-risk-score
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    CPT 81506: Diabetes Risk Score from Biochemical Assays

    CPT code 81506 describes a laboratory service in which a technician performs seven biochemical assays related to diabetes and an algorithmic analysis of the lab results combined with patient data to generate and report a patient risk score; service type: laboratory testing with algorithmic/analytic reporting, typical site of service: clinical laboratory or reference laboratory.

    For related coverage guidance, see recent payer policy updates: Oral Cancer Screening and Testing, RTM Testing for Alpha-1 Antitrypsin Deficiency, Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policy.

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    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with type 2 diabetes mellitus presents for routine management and risk stratification. The clinician orders a laboratory panel that includes seven biochemical assays (such as hemoglobin A1c, fasting glucose, C-peptide, insulin, lipid markers, serum creatinine, and urinary albumin) processed by a clinical laboratory. The lab analyst performs the technical assays and inputs patient demographic and clinical data into a validated algorithmic analytic platform which calculates and reports a composite patient risk score for diabetes-related complications. Results are delivered to the ordering clinician and integrated into the electronic health record to inform longitudinal care planning and potential referral to endocrinology, nephrology, or cardiology.

    Typical site of service: Clinical reference laboratory or hospital laboratory with a certified clinical laboratory improvement amendments (CLIA) waiver or appropriate CLIA certification. The specimen is collected in an outpatient clinic, physician office, or hospital outpatient phlebotomy service and shipped to the performing laboratory.

    Typical patient scenario: An outpatient visit for diabetes follow-up where the clinician documents medication adherence concerns, recent weight change, and a need to stratify risk for microvascular and macrovascular complications. The clinician orders the composite biomarker panel with algorithmic analysis to guide intensity of monitoring and referrals. The laboratory performs the seven assays, runs the algorithm, and returns a calculated patient risk score with interpretive comments to the ordering provider.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    80048Basic metabolic panel; 8 or fewer testsCommon panel performed alongside diabetes biomarker testing to assess metabolic status and renal function prior to algorithmic risk calculation.
    83036Hemoglobin; glycosylated (A1c)Frequently included among the biochemical assays used in diabetes risk algorithms and routinely ordered with this composite test.
    81025Urine dipstick or multistixPerformed to screen for urinary abnormalities such as albuminuria that contribute to diabetes complication risk scoring.
    84443Thyroid stimulating hormone (TSH)May be ordered concurrently to evaluate secondary contributors to glycemic control and cardiovascular risk profile.
    84301Urine microalbumin; quantitativeUsed to detect early diabetic nephropathy and often forms a direct input to diabetes complication risk algorithms.
    36415Collection of venous blood by venipunctureSpecimen collection code used at the time of drawing blood for the seven biochemical assays and subsequent algorithmic analysis.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    207RH0000X
    207K00000X
    208D00000X
    207L00000X
    2278E1000X
    156FC0801X
    2251S0007X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    E10.65Type 1 diabetes mellitus with hyperglycemia
    E10.9Type 1 diabetes mellitus without complications
    E11.22Type 2 diabetes mellitus with diabetic chronic kidney disease
    E11.29Type 2 diabetes mellitus with other diabetic kidney complication
    E11.42Type 2 diabetes mellitus with diabetic polyneuropathy
    E11.51Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
    E11.65Type 2 diabetes mellitus with hyperglycemia
    E11.69Type 2 diabetes mellitus with other specified complication
    E11.8Type 2 diabetes mellitus with unspecified complications
    E11.9Type 2 diabetes mellitus without complications

    Showing 1–10 of 29

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Carrier Testing Panels for Genetic Diseases (for Kentucky Only)UnitedHealthcare2026-10-01
    Genetic Testing for Neurological Disorders (for Kansas Only)UnitedHealthcare2026-10-01
    Genetic and Molecular TestingProvidence Health Plan2026-10-01
    Cell-Free Fetal DNA Testing (for Idaho Only)UnitedHealthcare2026-10-01
    Next Generation Sequencing for Minimal Residual Disease DetectionProvidence Health Plan2026-10-01
    Pharmacogenetic Panel Testing (for Kansas Only)UnitedHealthcare2026-10-01
    Non-Covered Genetic Panel TestsProvidence Health Plan2026-10-01

    Related Codes

    CPT-81490-RA-DISEASE-ACTIVITY-SCORE-SERUM-BIOMARKER-PANEL

    CPT 81490: Serum Biomarker Panel and RA Disease Activity Score

    CPT-81493-CORONARY-ARTERY-DISEASE-23-GENE-RT-PCR-RISK-SCORE

    CPT 81493: 23-Gene RT-PCR Molecular Test With CAD Risk Score

    CPT-81500-CA125-HE4-ALGORITHMIC-RISK-SCORE

    CPT 81500: Algorithmic Risk Score Using CA-125 and HE4

    CPT-81503-ALGORITHMIC-LAB-RISK-SCORE-CA125-APOLIPOPROTEIN-A1

    CPT 81503: Algorithmic Risk Score from Multiple Lab Markers

    CPT-81504-TUMOR-ORIGIN-RNA-EXPRESSION-CLASSIFIER

    CPT 81504: Tumor RNA Expression Profile Comparison

    CPT-81507-NIPS-CELL-FREE-DNA-TRISOMY-RISK-ANALYSIS

    CPT 81507: Noninvasive Prenatal Testing for Trisomies 13, 18, 21

    CPT-81508-PAPP-A-HCG-ALGORITHMIC-RISK-ASSAY

    CPT 81508: First-Trimester PAPP-A and hCG Risk Score

    CPT-81509-LAB-ALGORITHMIC-RISK-ASSESSMENT-PAPP-A-HCG-DIA

    CPT 81509: Prenatal Biochemical Risk Score from PAPP–A, hCG, DIA

    CPT-81510-PRENATAL-TRIPLE-MARKER-ALGORITHMIC-RISK-ASSESSMENT

    CPT 81510: Prenatal Serum Screening with Algorithmic Risk Score

    CPT-81511-MULTIANALYTE-SERUM-SCREENING-ALGORITHMIC-RISK-SCORE

    CPT 81511: Maternal Serum Quadruple Marker Risk Score

    Showing 1–10 of 41

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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