CommercialCoverageMedium impact
Non-Invasive Fetal Membranes Rupture Tests (CPB 0757, reviewed 2026-10-21)
Aetna·OB-GYN, Radiology·Medical Policy
We identified it
Oct 22, 2026
Summary
Aetna's Clinical Policy Bulletin 0757 (reviewed 2026-10-21) designates multiple non-invasive fetal membrane rupture tests as experimental, investigational, or unproven, including Actim PROM, AmniSure ROM, Chorioquick, ROM Plus, and related imaging/biomarker tests. These tests are not covered for any indication, and specific CPT, HCPCS, and ICD-10 codes are listed as non-covered.
Action Required
Billing team should verify current applicability of this policy and confirm whether Aetna has established an effective date for this review (published 2026-10-21). The source does not state an explicit effective date for coverage changes. Update internal billing guidelines and denial management protocols to reflect that CPT codes 76391, 76811, 76812, 76981, 76982, 76983, 84112, 74712, and 74713—when billed for the non-covered indications listed (fetal membrane rupture detection, vaginal microbiome evaluation, placental MRI for infection/inflammation assessment, and amniotic fluid suPAR testing)—will be denied as non-covered experimental services. Train billing staff to recognize claims for these services and apply appropriate denial codes. Contact Aetna directly to confirm the effective implementation date if not yet established.