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Fetal Fibronectin, Inflammatory Biomarkers, and Salivary Hormone Testing for Preterm Labor (CPB 0166, reviewed 2026-04-21)

Aetna·OB-GYN·Medical Policy
Effective date
Apr 21, 2026
We identified it
Aug 17, 2026
Days to comply

Summary

Aetna's updated policy (CPB 0166, effective 2026-04-21) establishes coverage criteria for fetal fibronectin (fFN) immunoassay testing in symptomatic pregnant women at high risk for preterm labor, while classifying numerous inflammatory biomarkers and salivary hormone tests as experimental/investigational and therefore non-covered. Billing teams must immediately update systems to enforce strict gestational age windows (24+0 to 34+6 weeks), repeat testing rules (2+ weeks post-negative result), and exclude coverage for 40+ specific biomarker tests and salivary assays.

Action Required

Action needed
IMMEDIATE (effective 2026-04-21): Billing team must update authorization and claim processing rules in billing software: (1) CPT 82731 (fetal fibronectin) is COVERED ONLY when ALL criteria are met—intact membranes, cervical dilation <3cm, gestational age 24+0 to 34+6 weeks, and results available for real-time clinical decision-making. Implement system edits to reject claims outside this window. (2) Repeat testing (CPT 82731) requires patient to remain symptomatic 2+ weeks after prior negative result—update prior authorization logic to enforce this rule. (3) HCPCS S3652 (salivary hormone test) and 40+ biomarker tests (CPT codes 0247U, 81291, 82085, 82103, 82131, 82542, 82677, 82728, 83006, 83516, 83518, 83519, 83520, 84112, 84144, 84145, 84210, 84466, 84550, 85415, 86140, 86141, 88324, 84560 and others) are NON-COVERED as experimental—update denial rules in billing system and flag claims for automatic rejection. (4) Do NOT cover CPT 82731 following cervical cerclage (CPT 59320). (5) Do NOT cover ultrasound CPT 76815 for amniotic fluid sludge evaluation. (6) Update encounter templates and clinical decision support to remind OB/GYN providers of these restrictions at point of care. Provider education required to prevent ordering of non-covered biomarkers. Claims submitted without meeting medical necessity criteria will be denied; failure to implement these rules will result in claim rejections and compliance issues.

Affected Billing Codes

82731
81291
81401
82085
82103
82131
82542
82677
82728
83006
83516
83518
83519
83520
84112
84144
84145
84210
84466
84550
85415
86140
86141
88324
59320
76815
84560
S3652
N88.3
O09.211
O09.212
O09.213
O09.219
O34.30
O34.31
O34.32
O34.33
O47.00
O47.01
O47.02
O47.03
O47.1
O47.9
O60.00
O60.01
O60.02
O60.03
Z87.51