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CPT 81510: Prenatal Triple-Analyte Algorithmic Risk Assessment

CPT code 81510 denotes a laboratory-based algorithmic risk assessment that combines measured levels of AFP, uE3, and hCG with patient data to produce a reported patient risk score. This test is used in prenatal screening contexts to estimate risk for certain fetal conditions and is notable nationally for its role in noninvasive risk stratification that can influence downstream diagnostic and counseling decisions. Key payers in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the service definition, common payer coverage considerations, and clinical context for use. The publication outlines typical sites of service, common modifiers in billing practice, and operational implications for laboratories performing combined analyte measurement with algorithmic interpretation. It also highlights benchmarking and reimbursement themes relevant to labs and payers, policy updates affecting algorithm-based laboratory tests, and clinical considerations around prenatal screening workflows. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 81510 describes a laboratory service in which the lab analyst performs technical testing for three analytes — alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG) — and applies an algorithmic analysis using patient data and the test results to generate and report a patient risk score. The service type is a laboratory-based algorithmic risk assessment. The typical site of service is a clinical laboratory or centralized diagnostic testing facility, where specimen processing, immunoassays or equivalent analyte testing, and algorithmic computation are performed.

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CPT 81510: Prenatal Triple-Analyte Algorithmic Risk Assessment

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves a pregnant patient undergoing second‑trimester aneuploidy risk assessment. The ordering obstetric provider (obstetrician-gynecologist or maternal-fetal medicine specialist) collects a maternal serum sample and submits clinical data (maternal age, gestational age, weight, diabetes status, race/ethnicity, and prior obstetric history) with the specimen. The laboratory performs quantitative immunoassays for alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG), and then runs a validated algorithm that integrates the three analyte values with the patient data to generate a computed patient risk score for neural tube defects and chromosomal abnormalities (e.g., trisomy 21, trisomy 18). The lab analyst documents the technical testing, performs quality control, and reports the risk score and interpretation to the ordering provider via the laboratory information system. Typical site of service is an outpatient clinical laboratory or hospital clinical laboratory with specimen collection in an outpatient clinic, prenatal clinic, or physician office collection area. The service type is a laboratory algorithmic risk assessment based on assay results and patient data, representing the technical component of a multi-analyte biochemical screening test.

Coding Specifications

Modifier	Description	When to Use
`00`	Service not otherwise classified (placeholder)	Rarely used; billers may use as payer-specific placeholder when no other modifier applies per payer guidance
`11`	Office or other outpatient visit, usual/normal service (CMS placeholder for professional component)	Not typically applied to lab codes; used by providers for professional component when applicable per payer rules
`26`	Professional component	Use when reporting only the professional component (interpretation/analysis) separate from the laboratory technical component
`52`	Reduced services	Use when the lab performed a reduced version of the test per medical necessity or specimen limitations
`53`	Discontinued procedure	Use when testing was started but discontinued due to specimen or patient issues before completion
`59`	Distinct procedural service (note: not in provided list)	Data not available in the input.
`62`	Two surgeons	Generally not applicable to laboratory testing; included in list but rarely used for this service
`90`	Reference (outside) laboratory	Use when the performing laboratory is an outside/referral reference lab and billing must indicate outside lab service
`TC`	Technical component	Use when billing only the technical component of the test (assay performance, equipment, and lab personnel)
`26`	Professional component	(Duplicate entry removed in final billing; see above)

Taxonomy Code	Specialty	Notes
207Q00000X	Maternal and Fetal Medicine	Specialists who may order high-risk prenatal screening and interpret results
207L00000X	Obstetrics & Gynecology	Common ordering providers for prenatal biochemical screening
207K00000X	Clinical Genetics	May order or consult on risk calculations and genetic counseling
207LP2900X	Family Medicine	Primary care providers who provide prenatal care and order screening
3336C0002X	Clinical Laboratory	Laboratory director/clinical pathologist overseeing testing and reporting

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O09.511`	Supervision of other high-risk pregnancy, first trimester	High-risk pregnancy supervision prompts enhanced prenatal screening, including biochemical risk assays
`O09.512`	Supervision of other high-risk pregnancy, second trimester	Second-trimester biochemical screening timing aligns with this gestational period
`O09.513`	Supervision of other high-risk pregnancy, third trimester	May relate to late or follow-up testing and counseling
`Z34.90`	Encounter for supervision of normal pregnancy, unspecified, unspecified trimester	Routine prenatal care includes maternal serum screening in appropriate gestational windows
`Z36.0`	Encounter for antenatal screening for chromosomal anomalies	Directly indicates the clinical purpose of AFP/uE3/hCG algorithmic risk assessment
`Z31.69`	Encounter for other genetic counseling and testing	Genetic counseling often follows abnormal risk scores from biochemical screening
`R94.5`	Abnormal results of liver function studies	Included as a general abnormal lab result code when follow-up testing or interpretation is required

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81025`	Urinalysis; non-automated, with microscopy	Performed in prenatal visits to evaluate maternal health prior to or alongside serum screening
`36415`	Collection of venous blood by venipuncture	Specimen collection required before laboratory measurement of AFP, uE3, hCG and algorithmic risk analysis
`82040`	Albumin; urine, quantitative	Ancillary prenatal laboratory that may be ordered in the same panel of prenatal labs
`86705`	Rubella antibody, IgG	Prenatal serologies commonly ordered during the same prenatal visit as serum screening
`G0101`	Cervical cancer screening; collection of specimen for cyto or HPV	Preventive services frequently coordinated in prenatal care visits

CPT 81490: RA Disease Activity Score from 12-Serum Biomarker Panel

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

CPT 81493: 23-Gene RT-PCR Test with Algorithmic CAD Risk Score

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

CPT 81500: CA-125 and HE4 Laboratory Testing with Algorithmic Risk Score

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

CPT 81503: Algorithmic Laboratory Risk Score Using Multiple Biomarkers

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

CPT 81504: RNA Expression Tumor Origin Classifier

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

CPT 81506: Diabetes Biomarker Panel with Algorithmic Risk Score

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

CPT 81507: Non-Invasive Prenatal Screening for Trisomies 13, 18, 21

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

CPT 81508: PAPP–A and hCG Laboratory Assay with Algorithmic Risk Score

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

CPT 81509: Laboratory Algorithmic Risk Assessment for PAPP–A, hCG, DIA

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

CPT 81511: Multianalyte Serum Screening with Algorithmic Risk Score

Showing 1–10 of 41

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.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	Service not otherwise classified (placeholder)	Rarely used; billers may use as payer-specific placeholder when no other modifier applies per payer guidance
`11`	Office or other outpatient visit, usual/normal service (CMS placeholder for professional component)	Not typically applied to lab codes; used by providers for professional component when applicable per payer rules
`26`	Professional component	Use when reporting only the professional component (interpretation/analysis) separate from the laboratory technical component
`52`	Reduced services	Use when the lab performed a reduced version of the test per medical necessity or specimen limitations
`53`	Discontinued procedure	Use when testing was started but discontinued due to specimen or patient issues before completion
`59`	Distinct procedural service (note: not in provided list)	Data not available in the input.
`62`	Two surgeons	Generally not applicable to laboratory testing; included in list but rarely used for this service
`90`	Reference (outside) laboratory	Use when the performing laboratory is an outside/referral reference lab and billing must indicate outside lab service
`TC`	Technical component	Use when billing only the technical component of the test (assay performance, equipment, and lab personnel)
`26`	Professional component	(Duplicate entry removed in final billing; see above)

Taxonomy Code	Specialty	Notes
207Q00000X	Maternal and Fetal Medicine	Specialists who may order high-risk prenatal screening and interpret results
207L00000X	Obstetrics & Gynecology	Common ordering providers for prenatal biochemical screening
207K00000X	Clinical Genetics	May order or consult on risk calculations and genetic counseling
207LP2900X	Family Medicine	Primary care providers who provide prenatal care and order screening
3336C0002X	Clinical Laboratory	Laboratory director/clinical pathologist overseeing testing and reporting

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O09.511`	Supervision of other high-risk pregnancy, first trimester	High-risk pregnancy supervision prompts enhanced prenatal screening, including biochemical risk assays
`O09.512`	Supervision of other high-risk pregnancy, second trimester	Second-trimester biochemical screening timing aligns with this gestational period
`O09.513`	Supervision of other high-risk pregnancy, third trimester	May relate to late or follow-up testing and counseling
`Z34.90`	Encounter for supervision of normal pregnancy, unspecified, unspecified trimester	Routine prenatal care includes maternal serum screening in appropriate gestational windows
`Z36.0`	Encounter for antenatal screening for chromosomal anomalies	Directly indicates the clinical purpose of AFP/uE3/hCG algorithmic risk assessment
`Z31.69`	Encounter for other genetic counseling and testing	Genetic counseling often follows abnormal risk scores from biochemical screening
`R94.5`	Abnormal results of liver function studies	Included as a general abnormal lab result code when follow-up testing or interpretation is required

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81025`	Urinalysis; non-automated, with microscopy	Performed in prenatal visits to evaluate maternal health prior to or alongside serum screening
`36415`	Collection of venous blood by venipuncture	Specimen collection required before laboratory measurement of AFP, uE3, hCG and algorithmic risk analysis
`82040`	Albumin; urine, quantitative	Ancillary prenatal laboratory that may be ordered in the same panel of prenatal labs
`86705`	Rubella antibody, IgG	Prenatal serologies commonly ordered during the same prenatal visit as serum screening
`G0101`	Cervical cancer screening; collection of specimen for cyto or HPV	Preventive services frequently coordinated in prenatal care visits

CPT 81490: RA Disease Activity Score from 12-Serum Biomarker Panel

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

CPT 81493: 23-Gene RT-PCR Test with Algorithmic CAD Risk Score

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

CPT 81500: CA-125 and HE4 Laboratory Testing with Algorithmic Risk Score

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

CPT 81503: Algorithmic Laboratory Risk Score Using Multiple Biomarkers

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

CPT 81504: RNA Expression Tumor Origin Classifier

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

CPT 81506: Diabetes Biomarker Panel with Algorithmic Risk Score

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

CPT 81507: Non-Invasive Prenatal Screening for Trisomies 13, 18, 21

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

CPT 81508: PAPP–A and hCG Laboratory Assay with Algorithmic Risk Score

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

CPT 81509: Laboratory Algorithmic Risk Assessment for PAPP–A, hCG, DIA

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

CPT 81511: Multianalyte Serum Screening with Algorithmic Risk Score

Showing 1–10 of 41

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 81510: Prenatal Triple-Analyte Algorithmic Risk Assessment

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Billing Code Overview

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CPT 81510: Prenatal Triple-Analyte Algorithmic Risk Assessment

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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 81510: Prenatal Triple-Analyte Algorithmic Risk Assessment

Sign up for cpt 81510 policy alerts

Billing Code Overview

CPT 81510: Prenatal Triple-Analyte Algorithmic Risk Assessment

Sign up for cpt 81510 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical service is billed under CPT 81510 and where is it typically performed?

Which billing modifiers are commonly applicable to CPT 81510 and what do they indicate?

Who typically orders CPT 81510 and who performs and reports the test?

Are there related CPT codes or common ancillary procedures associated with CPT 81510?

Which payers are listed for CPT 81510 and does the page provide coverage or reimbursement rates?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical service is billed under CPT 81510 and where is it typically performed?

Which billing modifiers are commonly applicable to CPT 81510 and what do they indicate?

Who typically orders CPT 81510 and who performs and reports the test?

Are there related CPT codes or common ancillary procedures associated with CPT 81510?

Which payers are listed for CPT 81510 and does the page provide coverage or reimbursement rates?

References