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.

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

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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 Code	Description	Relationship to This Procedure
`81025`	Urinalysis, 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 microscopy	Performed at the obstetric visit for baseline prenatal assessment; not directly part of serum aneuploidy testing but commonly performed same visit.
`36415`	Collection of venous blood by venipuncture	The venipuncture procedure used to collect the maternal serum sample sent to the lab for `81509` testing.
`81000`	Urinalysis, nonautomated, without microscopy	Another common point‑of‑care prenatal test performed at the same encounter.
`88360`	Immunohistochemistry or special stains; per specimen; initial single antibody stain	Occasionally used in ancillary pathology workflows when tissue analysis is required in parallel pregnancies with complications; not routine for serum aneuploidy testing.
`81420`	Molecular 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`.
`81000`	Routine urinalysis (duplicate entry for common prenatal panel)	See above — frequently ordered at same prenatal visit.

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 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…
90	Modifier ‑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…
52	Modifier ‑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…
53	Modifier 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…
22	Modifier –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	Specialty	Notes
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
364S00000X	Clinical Nurse Specialist	A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
207VM0101X	Maternal & Fetal Medicine Physician	An obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowle…
207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	An emergency medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illn…
363LA2100X	Acute Care Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
364SP0810X	Child & Family Psychiatric/Mental Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist

Related ICD-10-CM Codes

16 rows

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

Showing 1–10 of 16

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.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.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.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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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81025`	Urinalysis, 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 microscopy	Performed at the obstetric visit for baseline prenatal assessment; not directly part of serum aneuploidy testing but commonly performed same visit.
`36415`	Collection of venous blood by venipuncture	The venipuncture procedure used to collect the maternal serum sample sent to the lab for `81509` testing.
`81000`	Urinalysis, nonautomated, without microscopy	Another common point‑of‑care prenatal test performed at the same encounter.
`88360`	Immunohistochemistry or special stains; per specimen; initial single antibody stain	Occasionally used in ancillary pathology workflows when tissue analysis is required in parallel pregnancies with complications; not routine for serum aneuploidy testing.
`81420`	Molecular 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`.
`81000`	Routine urinalysis (duplicate entry for common prenatal panel)	See above — frequently ordered at same prenatal visit.

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 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…
90	Modifier ‑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…
52	Modifier ‑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…
53	Modifier 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…
22	Modifier –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	Specialty	Notes
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
364S00000X	Clinical Nurse Specialist	A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
207VM0101X	Maternal & Fetal Medicine Physician	An obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowle…
207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	An emergency medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illn…
363LA2100X	Acute Care Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
364SP0810X	Child & Family Psychiatric/Mental Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist

Related ICD-10-CM Codes

16 rows

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

Showing 1–10 of 16

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.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.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.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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OpenPayer

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

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

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

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

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

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What clinical service does CPT 81509 represent and where is it typically performed?

Which billing modifiers are relevant to CPT 81509 and when are they used?

What other CPT codes are commonly billed in the same encounter as 81509?

What ICD‑10 diagnoses are associated with ordering CPT 81509?

Which payers are referenced for coverage and what does the code capture in terms of services?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What clinical service does CPT 81509 represent and where is it typically performed?

Which billing modifiers are relevant to CPT 81509 and when are they used?

What other CPT codes are commonly billed in the same encounter as 81509?

What ICD‑10 diagnoses are associated with ordering CPT 81509?

Which payers are referenced for coverage and what does the code capture in terms of services?

References