#Strip test for amniotic fluid code#
#Strip test for amniotic fluid plus#

O00.00 - O08.9, O10.011 - O26.93 O29.011 - O30.019, O30.031 - O35.6xx+ O36.011+ - O9a.53Ĭomplications of pregnancy, childbirth, and the puerperiumĮncounter for other specified antenatal screening įunctional placental magnetic resonance imaging: ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):

#Strip test for amniotic fluid code#

HCPCS codes not covered for indications listed in the CPB:īiobeat Monitoring Platform - no specific code Ultrasound, elastography parenchyma (eg, organ)Įvaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (eg, placental alpha microglobulin-1, placental protein 12, alpha-fetoprotein), qualitative, each specimen

#Strip test for amniotic fluid plus#

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach single or first gestationĮach additional gestation (List separately in addition to code for primary procedure)

Magnetic resonance (eg, vibration) elastography Placental alpha-micro globulin-1 (PAMG-1), immunoassay with direct optical observation, cervico-vaginal fluid, each specimen Codes requiring a 7th character are represented by '+':ĬPT codes not covered for indications listed in the CPB:Įvaluation of vaginal microbiome profiles, fusion MRI imaging, magnetic resonance elastography, optical coherence elastography, optical coherence tomography or shear wave elastography - no specific codes: Information in the below has been added for clarification purposes. Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code Non-invasive fetal membranes rupture tests (e.g., Actim PROM, AmniSure ROM, Chorioquick, and the ROM Plus Fetal Membranes Rupture Test) for detecting preterm ROM and all other indications.Functional placental magnetic resonance imaging for evaluation of infection/inflammation in women with preterm premature ROM.Fetal membrane imaging (e.g., fusion MRI imaging, magnetic resonance elastography, optical coherence elastography, optical coherence tomography, shear wave elastography, and ultrasonography) for detecting preterm ROM.Evaluation of vaginal microbiome profiles for detecting preterm ROM.Biobeat Monitoring Platform for monitoring rupture of membranes (ROM).

This Clinical Policy Bulletin addresses selected non-invasive tests for premature rupture of membranes.Īetna considers the following interventions experimental and investigational because the effectiveness of these approaches has not been established: Number: 0757 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References