2025 CPT code 81500
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Multianalyte Assays with Algorithmic Analyses (MAAAs) Pathology and Laboratory Feed
This code represents the Risk of Ovarian Malignancy Algorithm (ROMA) test, a multianalyte assay with algorithmic analysis (MAAA) that uses CA-125 and HE4 protein levels along with menopausal status to calculate a risk score for ovarian malignancy.
Modifiers may be applicable depending on the specific circumstances of service. Refer to the CPT manual for guidance on modifier usage.
Medical necessity for the ROMA test is generally established when there is a clinical suspicion of ovarian cancer based on symptoms, family history, or imaging findings.The test is used to aid in risk stratification and to guide further management decisions.Payer-specific criteria may vary.
The clinical laboratory performs the technical aspects of the test (sample collection, analysis, and algorithmic computation). The ordering physician interprets the results in the context of the patient's clinical presentation and other diagnostic findings.
- Pathology and Laboratory
- Pathology and Laboratory Procedures > Multianalyte Assays with Algorithmic Analyses
In simple words: This blood test helps determine the risk of ovarian cancer. It measures two proteins (CA-125 and HE4) and considers whether a woman is in menopause.The results are combined in a special computer program to provide a score predicting the chance of having ovarian cancer.
This CPT code, 81500, encompasses the Risk of Ovarian Malignancy Algorithm (ROMA) test, a multianalyte assay with algorithmic analysis (MAAA).The procedure involves biochemical assays of two proteins, CA-125 (cancer antigen 125) and HE4 (human epididymis protein 4), utilizing a serum specimen. Patient menopausal status is also incorporated into a proprietary algorithm. The final result is reported as a risk score indicating the likelihood of ovarian malignancy.The code includes all analytical services necessary for the test, including specimen processing (e.g., cell lysis, nucleic acid extraction, amplification, hybridization, and detection), data input, algorithmic analysis, and report generation.Importantly, codes for the individual component tests (86304 and 86305) are not reported separately when using this MAAA code.
Example 1: A 55-year-old female patient presents with abdominal bloating and pelvic pain.The physician orders the ROMA test (81500) to assess the risk of ovarian cancer before proceeding with further imaging or surgical intervention., A 40-year-old woman with a family history of ovarian cancer undergoes regular screening.Her physician orders the ROMA test annually to monitor for any changes in her risk profile., A 60-year-old post-menopausal woman with an adnexal mass detected on ultrasound undergoes the ROMA test to determine if further evaluation (e.g., biopsy) is needed.
* Patient demographics (age, gender, menopausal status)* Clinical indications for testing (symptoms, family history, imaging findings)* Complete laboratory report including CA-125 and HE4 levels and the calculated ROMA score* Physician's interpretation of results and plan of care
** This code is subject to payer-specific coverage policies. Some payers may not reimburse for MAAA codes and might require separate billing for the individual component tests (86304 and 86305).
- Revenue Code: Z2 (Undefined Codes)
- RVU: Information not available in provided sources.RVUs vary based on payer and location. Consult your local payer's fee schedule.
- Global Days: Not applicable. This is a laboratory test, not a surgical procedure.
- Payment Status: Active (but payment acceptance varies by payer; some may require separate billing for the individual component tests).
- Modifier TC rule: Not applicable. This is a comprehensive laboratory test code.
- Fee Schedule: Information not available in provided sources. Fee schedules vary by payer and geographic location. Consult your local payer's fee schedule.
- Specialties:Gynecology, Oncology
- Place of Service:Office, Hospital outpatient, Laboratory