2025 CPT code 81507

Analysis of maternal plasma DNA to assess risk for fetal trisomies 13, 18, and 21, using an algorithm to generate a risk score for each trisomy.

Adhere to CPT coding guidelines for MAAA tests, including accurate reporting of the procedure performed and any applicable modifiers.

Modifiers may apply depending on the circumstances. Consult CPT guidelines and payer specific rules.

Medical necessity for this test is typically established based on patient factors such as advanced maternal age, abnormal ultrasound findings, or family history of chromosomal abnormalities.Payers may have specific criteria for coverage.

The clinical laboratory performs the assay and algorithmic analysis, generating a report with risk scores for each trisomy.

IMPORTANT Use unlisted code 81599 only if no other Category I or Appendix O MAAA code applies. Do not report 81228, 81229, 88271 with this code if performing genomic sequencing or other molecular multianalyte assays for copy number analysis. For cytogenomic analysis (genome-wide) use 81349.

In simple words: This lab test analyzes a pregnant woman's blood to check the risk of her baby having Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), or Patau syndrome (trisomy 13). The test uses advanced technology to look for specific DNA patterns and a computer program calculates the risk for each condition.

This CPT code encompasses a multianalyte assay with algorithmic analysis (MAAA) for the detection of fetal trisomies 13, 18, and 21.The procedure involves DNA sequence analysis of selected regions in maternal plasma, followed by an algorithmic analysis incorporating patient data and assay results. The final report provides a risk score for each trisomy. The code includes all analytical services, such as cell lysis, nucleic acid extraction, amplification, hybridization, and detection, in addition to the algorithmic analysis and report generation.Procedures preceding cell lysis (e.g., microdissection, codes 88380 and 88381) are reported separately.

Example 1: A 35-year-old pregnant woman undergoes screening for fetal aneuploidy.Maternal plasma is collected and sent to the lab for analysis using code 81507. The lab report provides low risk scores for trisomies 13, 18, and 21., A pregnant woman with a family history of Down syndrome requests non-invasive prenatal testing.Her physician orders the Harmony™ Prenatal Test (81507) and receives a high risk score for trisomy 21, leading to further diagnostic testing., A 28-year-old woman with an ultrasound suggesting a possible chromosomal abnormality is advised to undergo testing with 81507. The result reveals an intermediate risk for trisomy 18.Further testing is recommended to confirm the findings.

* Physician's order for the test.* Patient demographics and medical history.* Date and time of sample collection.* Confirmation of appropriate sample handling and transport.* Complete laboratory report including risk scores for each trisomy.

** This code represents the complete testing process, including laboratory analysis and algorithmic interpretation.Individual component tests are not separately reported.

  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:Obstetrics, Gynecology, Genetics, Clinical Laboratory
  • Place of Service:Clinical Laboratory
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