Non-Invasive Fetal Membranes Rupture Tests | Aetna

Non-Invasive Fetal Membranes Rupture Tests

Aetna · PayerPolicy · AETNA-CPB-0757

Status: Active
Effective: October 17, 2023
Last reviewed by Aetna: November 12, 2025
Last checked by Backwork: August 1, 2026

Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.

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Codes in this policy

Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
74712	CPT	Covered
74713	CPT	Covered
76391	CPT	Covered
76811	CPT	Covered
76812	CPT	Covered
76981	CPT	Covered
76982	CPT	Covered
76983	CPT	Covered
84112	CPT	Covered
Z34.00	ICD10CM	Covered
Z34.93	ICD10CM	Covered
Z36.89	ICD10CM	Covered