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    v1.0.30
    OpenPayerBilling CodesMultianalyte Assays with Algorithmic AnalysesCPT cpt-81509-lab-algorithmic-risk-assessment-papp-a-hcg-dia
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    CPT 81509: Prenatal Biochemical Risk Score from PAPP–A, hCG, DIA

    CPT code 81509 describes a laboratory-based algorithmic maternal serum screening in which the lab performs technical tests measuring PAPP–A, hCG, and DIA proteins and combines those results with patient data to produce a patient risk score used for prenatal risk assessment; the service is a laboratory algorithm/analysis typically performed in a clinical laboratory or specialized prenatal testing laboratory (remote/outpatient lab setting) and reported as a discrete molecular/diagnostic lab test result.

    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 pregnant patient between 9 and 14 weeks' gestation presents for first‑trimester aneuploidy screening. The obstetrician orders a maternal serum screen that includes measurement of pregnancy‑associated plasma protein A (PAPP‑A), free beta‑human chorionic gonadotropin (hCG), and cell‑free DNA or a Dia protein panel (DIA) as part of a combined biochemical and algorithmic risk assessment. A phlebotomy technician collects a serum specimen at an outpatient OB clinic or women's health lab. The specimen is sent to a certified clinical laboratory where a laboratory analyst performs the technical assays for the three proteins and enters patient demographic and gestational age data into a validated proprietary algorithm. The lab generates a patient‑specific risk score for common aneuploidies and reports results electronically to the ordering provider. Typical site of service is an outpatient hospital laboratory, independent diagnostic testing facility, or hospital-based pathology lab. Common clinical workflow steps include order placement by the obstetric provider, specimen collection, sample accessioning and analysis in the lab, algorithmic computation of risk, and issuance of a final report to the ordering clinician for counseling and follow‑up testing decisions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    81025Urinalysis, by dipstick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non‑automated, with microscopyPerformed at the obstetric visit for baseline prenatal assessment; not directly part of serum aneuploidy testing but commonly performed same visit.
    36415Collection of venous blood by venipunctureThe venipuncture procedure used to collect the maternal serum sample sent to the lab for 81509 testing.
    81000Urinalysis, nonautomated, without microscopyAnother common point‑of‑care prenatal test performed at the same encounter.
    88360Immunohistochemistry or special stains; per specimen; initial single antibody stainOccasionally used in ancillary pathology workflows when tissue analysis is required in parallel pregnancies with complications; not routine for serum aneuploidy testing.
    81420Molecular pathology procedure, genomic sequence analysis, prenatal or pediatric (eg, targeted sequencing)Performed when follow‑up diagnostic genetic testing (such as targeted sequencing) is indicated after an abnormal risk score from 81509.
    81000Routine urinalysis (duplicate entry for common prenatal panel)See above — frequently ordered at same prenatal visit.

    Related Modifiers

    5 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…
    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…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    207Q00000X
    364S00000X
    207K00000X
    207VM0101X
    207PH0002X
    363LA2100X
    364SP0810X

    Related ICD-10-CM Codes

    16 rows

    ICD-10-CM CodeDescription
    O09.211Supervision of pregnancy with history of pre-term labor, first trimester
    O09.219Supervision of pregnancy with history of pre-term labor, unspecified trimester
    O09.512Supervision of elderly primigravida, second trimester
    O09.519Supervision of elderly primigravida, unspecified trimester
    O09.612Supervision of young primigravida, second trimester
    O09.619Supervision of young primigravida, unspecified trimester
    O09.92Supervision of high risk pregnancy, unspecified, second trimester
    O09.93Supervision of high risk pregnancy, unspecified, third trimester
    Z31.41Encounter for fertility testing
    Z31.83Encounter for assisted reproductive fertility procedure cycle

    Showing 1–10 of 16

    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-81506-DIABETES-BIOMARKER-PANEL-WITH-RISK-SCORE

    CPT 81506: Diabetes Risk Score from Biochemical Assays

    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-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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