2025 CPT code 81512
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Multianalyte Assays with Algorithmic Analyses Pathology and Laboratory Procedures Feed
This code represents a multianalyte assay with algorithmic analysis (MAAA) that uses results from multiple analytes and patient data to generate a risk score.It includes all analytical services and the algorithmic analysis.
Modifiers may be applicable depending on the circumstances of service.Consult the CPT manual and payer guidelines for appropriate modifier use.
Medical necessity is determined by the ordering physician's assessment of the patient's clinical condition and the need for the information provided by the MAAA test to guide management decisions. Documentation must clearly support the medical necessity for the test based on clinical indications.Individual payer policies may have specific requirements.
The clinical responsibility lies with the ordering physician who interprets the results of the algorithmic analysis in the context of the patient's clinical presentation and other diagnostic information. The laboratory performs the technical analysis and reporting of the calculated risk score.
- Pathology and Laboratory Procedures
- Pathology and Laboratory Procedures > Multianalyte Assays with Algorithmic Analyses
In simple words: This lab test combines the results of several individual tests with patient information to calculate a risk score. It's like a sophisticated calculation that helps predict the likelihood of certain conditions, such as Down syndrome during pregnancy.All the smaller tests are included in the overall price of this one code.
CPT code 81512 encompasses a comprehensive multianalyte assay with algorithmic analysis (MAAA).This procedure involves the analysis of multiple analytes (e.g., AFP, uE3, total and hyperglycosylated hCG, DIA) using various methodologies (e.g., immunoassays, molecular pathology techniques). The results of these individual analytes, along with other relevant patient information, are fed into an algorithm to produce a single, clinically significant risk score or probability index. The code includes all analytical services required to obtain the raw data, the algorithmic analysis itself, and the reporting of the final risk score.This is in contrast to separately reporting the individual component assays; the MAAA code represents a new, independent medical property derived from the combined analysis.
Example 1: A pregnant woman undergoes a maternal serum screen (penta screen) to assess the risk of fetal chromosomal abnormalities (e.g., Down syndrome, trisomy 18). The results from AFP, uE3, total hCG, hyperglycosylated hCG, and DIA are combined with patient data to generate a risk score, coded as 81512., A patient with suspected early-stage ovarian cancer undergoes a MAAA test using a panel of tumor markers. The results of these markers, together with the patient's medical history and imaging data, are analyzed using an algorithm, resulting in a risk assessment for cancer progression. This assessment is coded using 81512., A patient with an autoimmune disease has a panel of serum proteins analyzed, along with their medical history, through a MAAA test. The output provides an individualized risk score for disease activity.The laboratory would use CPT code 81512 to report this complex analysis and resulting score.
The requisition must include complete patient demographics, relevant medical history, date of collection, gestational age (if applicable), informed consent, and any other information specified by the laboratory for accurate interpretation of the results.Detailed information on the specific analytes analyzed (names and methods) is necessary for accurate coding.
** The specific analytes and algorithm used may vary depending on the laboratory and the clinical indication.Always refer to the laboratory's specific test information for details. Some payers may not recognize MAAA codes and require billing of individual component tests instead.
- Revenue Code: Z2 (Undefined Codes)
- RVU: Information not available in provided text.Refer to the AMA CPT codebook or CMS fee schedules for RVU data.
- Global Days: Not applicable.This is a laboratory test, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not typically used with this code since it encompasses both professional and technical components.
- Fee Schedule: Information not available in provided text. Refer to the AMA CPT codebook or CMS fee schedules for historical fee data.
- Specialties:Obstetrics and Gynecology, Oncology, and other specialties where MAAA testing is clinically indicated.
- Place of Service:Office, Hospital (inpatient and outpatient), Ambulatory Surgical Center, and other appropriate settings.