LAB.00029 Rupture of Membranes Testing in Pregnancy

This policy addresses lab assays of cervicovaginal fluid for amniotic fluid proteins (e.g., PAMG-1, PP12/IGFBP-1, alpha-fetoprotein; devices such as AmniSure or ROM Plus) to evaluate suspected rupture of membranes in pregnancy. Anthem considers these biomarker tests not medically necessary and does not cover them for any indication, including detection of preterm or term PROM/PPROM (HCPCS/CPT 84112). No exceptions are noted; the noncoverage applies regardless of clinical presentation, gestational age, or risk factors.

"Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s), (for example, placental alpha microglobulin-1 [PAMG-1], placental protein 12 [PP12], alpha-fetoprotein), is considerednot ..."

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