Summary & Overview
CPT 82106: Amniotic Fluid Alpha-Fetoprotein Quantitative
CPT code 82106 denotes a quantitative assay of amniotic fluid alpha-fetoprotein (AFP), a prenatal laboratory test usually performed during the 11th to 15th week of gestation. This test helps assess fetal development and can contribute to the evaluation of neural tube defects, abdominal wall defects, and other fetal conditions. Nationally, laboratory-based prenatal screening such as amniotic fluid AFP is a recognized component of obstetric diagnostic workflows and has implications for clinical decision-making and follow-up testing.
Key payers commonly engaged with this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and prior authorization requirements vary by payer and plan type; clinicians and billing staff often consult payer-specific policies for laboratory and prenatal diagnostic services.
Readers will find clinical context for when this assay is used, the typical sites where the service is delivered, and what to expect in payer interactions. The publication also provides benchmarks and policy-focused updates relevant to laboratory prenatal testing, explains common billing considerations for this service line, and summarizes how this CPT code fits into prenatal diagnostic pathways. Data not available in the input includes specific payer coverage rules, associated ICD-10 diagnoses, and related CPT or ancillary codes.
Billing Code Overview
CPT code 82106 reports a quantitative measurement of alpha-fetoprotein (AFP) in amniotic fluid, typically performed during the 11th to 15th week of gestation. The assay measures AFP produced by the fetal liver and yolk sac and is used as part of prenatal diagnostic evaluation.
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Service type: Laboratory testing — quantitative amniotic fluid AFP assay
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Typical site of service: Obstetric clinic or hospital-based outpatient laboratory with amniocentesis specimen collection
Clinical & Coding Specifications
Clinical Context
A 30-year-old pregnant patient at 12 weeks gestation presents to the outpatient obstetrics clinic for routine prenatal screening. The obstetrician orders an amniotic fluid alpha-fetoprotein quantitative assay to assess fetal neural tube defects and chromosomal abnormalities risk given maternal age and prior obstetric history. The patient undergoes an amniocentesis performed in the ambulatory surgery center by an MFM specialist; a laboratory technologist receives the fluid specimen and performs the 82106 assay to quantify amniotic fluid alpha-fetoprotein. Results are reported to the ordering obstetrician and documented in the prenatal chart, with follow-up counseling provided based on results.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional (interpretation) component if the laboratory or facility bills the technical component separately. |
59 | Distinct procedural service | Use when 82106 is performed on a different anatomic site or during a separate encounter from another procedure and additional documentation supports distinct service. |