CommercialCoverageHigh impact
Non-Invasive Fetal Membranes Rupture Tests (CPB 0757, reviewed 2025-11-12)
Aetna·OB-GYN·Medical Policy
Effective date
Nov 12, 2025
We identified it
Aug 19, 2026
Summary
Aetna has classified non-invasive fetal membrane rupture tests (including Actim PROM, AmniSure ROM, Chorioquick, and ROM Plus) as experimental, investigational, or unproven and will not cover them. Additionally, related diagnostic methods including biobeat monitoring, vaginal microbiome evaluation, fetal membrane imaging, functional placental MRI, and amniotic fluid suPAR testing are now non-covered. Billing teams must deny claims for these procedures when billed to Aetna plans and update internal denial protocols.
Action Required
Effective immediately (2025-11-12): Billing team must update the billing system to deny or reject all claims for CPT codes 76391, 76811, 76812, 76981, 76982, 76983, 84112, 74712, and 74713 when submitted to Aetna plans with ICD-10 diagnoses O00.00-O08.9, O10.011-O26.93, O29.011-O30.019, O30.031-O35.6xx, O36.011-O9a.53, O42.00-O42.92, O09.00-O09.93, Z34.00-Z34.93, Z36.89, O41.1010-O41.1499, or P02.70. Create or update denial templates citing these procedures as experimental/investigational per CPB 0757. Providers must be notified that Actim PROM, AmniSure ROM, Chorioquick, ROM Plus tests, biobeat monitoring, vaginal microbiome analysis, fetal membrane imaging, functional placental MRI, and amniotic fluid suPAR testing are non-covered. Update patient consent forms and pre-authorization protocols to reflect non-coverage. Failure to implement these changes will result in claim denials and potential compliance issues.