![]() ![]() ICD-10 codes not covered for indications listed in the CPB (not all-inclusive): 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 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. ![]()
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