CPT 0018U ThyraMIR Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 0018U: ThyraMIR microRNA Thyroid Cancer Risk Assay

CPT code 0018U identifies ThyraMIR, a Proprietary Laboratory Analyses (PLA) molecular diagnostic that analyzes 10 microRNA sequences from a thyroid fine needle aspirate (FNA) and applies an algorithm using patient data to report a positive or negative result for increased thyroid cancer risk. PLA codes matter nationally because they uniquely identify manufacturer- or laboratory-specific tests, enabling payers and providers to track utilization, coverage, and clinical adoption of proprietary diagnostics.

Key payers included in the national coverage context are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical purpose of the assay, the typical service context, and what to expect in payer coverage discussions. The publication summarizes available benchmarks for utilization and reimbursement where reported, highlights policy and coding considerations relevant to PLA codes, and situates the test within thyroid nodule diagnostic workflows. It also outlines common billing modifiers and administrative items for operational planning.

Data not available in the input for associated taxonomies, specific ICD-10 mappings, related codes, and a detailed payer-by-payer coverage matrix.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 0018UPLA codemolecular diagnosticsthyroid nodulemicroRNA assayThyraMIRfine needle aspiratelaboratory testalgorithmic interpretation

Billing Code Overview

CPT code 0018U is a Proprietary Laboratory Analyses (PLA) code that describes ThyraMIR by Interpace Diagnostics. The test performs a gene analysis of 10 microRNA sequences from a thyroid fine needle aspirate (FNA) specimen and combines those laboratory results with patient data through an algorithm to report a positive or negative finding for increased thyroid cancer risk.

Service type: Molecular diagnostic laboratory test with algorithmic interpretation
Typical site of service: Clinical laboratory processing FNA specimens; results used in outpatient endocrine, cytology, or pathology settings

Clinical & Coding Specifications

Clinical Context

A typical patient is a 35–70-year-old adult presenting to an endocrinologist or otolaryngologist with a thyroid nodule identified on clinical exam or ultrasound. Ultrasound-guided fine needle aspiration (FNA) is performed and cytology returns an indeterminate result (for example, Bethesda category III: atypia of undetermined significance/follicular lesion of undetermined significance, or Bethesda IV: follicular neoplasm/suspicious for a follicular neoplasm). The treating clinician sends residual FNA material or a dedicated FNA specimen to a reference laboratory for molecular testing using the ThyraMIR assay (0018U).

The laboratory receives the FNA specimen, extracts RNA, measures expression of the panel of 10 microRNA sequences, and combines the molecular results with available clinical data through the proprietary algorithm to generate a report indicating increased or decreased risk of thyroid malignancy. The result is returned to the ordering provider, who integrates it with cytology, ultrasound features, patient risk factors, and patient preferences to inform management (surveillance versus diagnostic/therapeutic surgery). Typical sites of service are outpatient clinics, ambulatory surgery centers for the FNA procedure, and independent or hospital-based clinical reference laboratories for the 0018U assay. Billing is performed by the laboratory using the PLA code 0018U with appropriate specimen source and specimen collection documentation retained in the medical record.

Coding Specifications

Modifier	Description	When to Use

CPT 0315U: DecisionDx–SCC Gene Expression Risk Stratification

CPT-0453U-COLONAIQ-CFDNA-CTDNA-METHYLATION-PCR-ASSAY

CPT 0453U: ColonAiQ® cfDNA/ctDNA Methylation PCR Assay

CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

CPT 0008U: H. pylori Antibiotic Resistance Panel, Gene Sequence Analysis

CPT-0376U-ARTERAAI-PROSTATE-TEST-AI-PATHOLOGY-RISK-ASSESSMENT

CPT 0376U: ArteraAI Prostate Test, AI Pathology Risk Assessment

CPT-0350U-PHARMACOGENOMIC-NGS-27-GENE-PANEL-RIGHTMED

CPT 0350U: Pharmacogenomic NGS 27-Gene Panel (RightMed® Gene Report)

CPT-0091U-FIRSTSIGHTCRC-BLOOD-BASED-CTC-AND-CFDNA-TEST

CPT 0091U: FirstSightCRC™ Blood-Based CTC and cfDNA Test

CPT-0280U-VWF-COLLAGEN-IV-BINDING-ELISA

CPT 0280U: VWF Collagen IV Binding ELISA, Plasma

CPT-0267U-PRAXIS-WHOLE-GENOME-SEQUENCING-OPTICAL-GENOME-MAPPING

CPT 0267U: Combined Whole Genome Sequencing and Optical Genome Mapping

CPT-0284U-VWD-TYPE-2N-BINDING-ELISA

CPT 0284U: Versiti VWD Type 2N Binding ELISA Test

CPT-0073U-CYP2D7-2D6-HYBRID-GENE-TARGETED-SEQUENCE-ANALYSIS

CPT 0073U: CYP2D7–2D6 Hybrid Gene Targeted Sequence Analysis

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Taxonomy Code	Specialty	Notes
`207RH0000X`	Otolaryngology (ENT)	Common specialty performing thyroid FNA and coordinating testing.
`207K00000X`	Endocrinology	Frequently orders molecular testing for indeterminate thyroid cytology to guide management.
`2080P0800X`	Pathology	Pathologists oversee cytology interpretation and coordinate molecular testing workflows.
`261QM0800X`	Clinical Laboratory & Laboratory Medicine	Laboratories performing `0018U` testing and reporting results.
`207L00000X`	General Surgery	Surgeons managing thyroid nodules and using results to decide on operative intervention.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E04.1`	Nontoxic single thyroid nodule	Common indication for FNA and subsequent molecular testing with `0018U` when cytology is indeterminate.
`E04.2`	Nontoxic multinodular goiter	Individual nodules may be sampled and molecular testing used for risk stratification.
`E07.9`	Disorder of thyroid, unspecified	Used when a specific thyroid disorder is not yet defined and FNA/molecular testing is pursued.
`C73`	Malignant neoplasm of thyroid gland	Relevant when suspicion for malignancy exists; `0018U` helps estimate malignancy risk in indeterminate cytology.
`R22.1`	Localized swelling, mass and lump, neck	Symptom code tied to detection of thyroid nodules leading to FNA and molecular analysis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10021`	Fine needle aspiration without imaging guidance	Performed when FNA is done freehand; specimen source for `0018U`.
`10022`	Fine needle aspiration with imaging guidance	Performed when ultrasound guidance is used for FNA that provides the specimen for molecular testing with `0018U`.
`88312`	Cytopathology, evaluation of fine needle aspirate, including interpretation and report	Cytology interpretation typically reported alongside molecular testing results; helps determine need for `0018U`.
`88342`	Immunohistochemistry or special stains, per specimen	May be performed on FNA material in parallel to molecular studies for diagnostic clarification.
`81599`	Unlisted molecular pathology procedure	Occasionally used historically when a PLA code was not available; `0018U` supersedes unlisted coding for this proprietary assay.

`26`	Professional component	Use when billing only the professional interpretation component if the laboratory or pathologist separately bills interpretation from technical processing.
`TC`	Technical component	Use when billing only the technical component (laboratory processing) of the test.
`90`	Reference (outside) laboratory	Use when the service is performed by a laboratory other than the billing entity (report from a reference lab).
`91`	Repeat clinical diagnostic laboratory test (Note: not in provided list)	Data not available in the input.
`52`	Reduced services	Use when the test was partially performed or limited by specimen inadequacy or partial processing.
`53`	Discontinued procedure	Use if specimen collection or specimen processing was aborted and test could not be completed.
`59`	Distinct procedural service (Note: not in provided list)	Data not available in the input.
`76`	Repeat procedure by same physician (Note: not in provided list)	Data not available in the input.
`78`	Return to operating room for a related procedure (applicable if surgical follow-up after result)	Use when a separate surgical procedure is required within the postoperative global period that is directly related.
`80`	Assistant surgeon	Use when an assistant surgeon is documented during the FNA or surgical procedure in the associated workflow.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons for a related operative procedure.
`90`	Reference laboratory	Duplicate entry avoided; handled above.
`11`	Increased procedural services	Use when work is substantially greater than typically required for the FNA or specimen handling.
`22`	Unusual procedural services	Use when the laboratory or clinician documents significantly greater complexity for specimen collection or interpretation.
`52`	Reduced services	Duplicate entry avoided; handled above.

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