Summary & Overview
CPT 0025U: Tenofovir Quantitation in Urine via LC–MS/MS
CPT code 0025U denotes a Proprietary Laboratory Analyses (PLA) test: the Synergy Medical Laboratories (UrSur, Inc.) tenofovir quantitation in urine performed with liquid chromatography–tandem mass spectrometry (LC–MS/MS). This PLA code identifies a single, manufacturer- or laboratory-specific diagnostic assay used to measure tenofovir exposure, relevant to medication monitoring, adherence assessment, and pharmacokinetic evaluation. Nationally, PLA codes like 0025U matter because they enable unique identification and tracking of proprietary assays, support laboratory billing clarity, and can affect coverage and utilization patterns across payers.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical purpose and testing modality, typical sites of service, and payers considered in the coverage landscape. The publication summarizes available benchmarking and coverage context where present, notes common billing modifiers associated with laboratory services, and outlines what information is and is not available in the source data. The content is intended to inform billing, coding, and policy stakeholders about the nature of this PLA code, its clinical relevance, and the national payer context without offering clinical recommendations.
Billing Code Overview
CPT code 0025U is a Proprietary Laboratory Analyses (PLA) code that describes a single, manufacturer- or lab-specific test: the Synergy Medical Laboratories (UrSur, Inc.) tenofovir quantitation assay. The test measures tenofovir levels in urine using liquid chromatography with tandem mass spectrometry (LC–MS/MS).
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Service type: Proprietary laboratory pharmacologic quantitation (urine tenofovir measurement) using LC–MS/MS
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Typical site of service: Clinical laboratory or specialized reference laboratory performing LC–MS/MS urine assays
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Clinical & Coding Specifications
Clinical Context
A patient receiving antiretroviral therapy for HIV or hepatitis B presents for routine monitoring or suspected nonadherence or potential drug toxicity. The clinician orders a urine tenofovir quantitation by liquid chromatography–tandem mass spectrometry to assess recent tenofovir exposure and adherence, evaluate drug accumulation in renal impairment, or investigate a possible adverse effect. A typical workflow: the outpatient clinic or infusion center collects a random or timed urine specimen, labels and ships the specimen to Synergy Medical Laboratories (UrSur, Inc.) with test requisition information and relevant clinical history; the reference lab performs LC–MS/MS tenofovir quantitation and returns a numeric concentration with interpretive comments to the ordering provider; the clinician reviews results in the electronic health record and documents adherence counseling, dose adjustments, or further renal evaluation as indicated. Typical sites of service include outpatient clinics, specialty infectious disease or hepatology clinics, ambulatory infusion centers, and reference laboratory facilities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Not a valid modifier for Medicare billing (historical) | Rarely used; generally not applied to PLA testing |
11 | Office or outpatient E/M (standard) | Attach when billing in conjunction with unrelated office visits as appropriate per payer rules |
26 | Professional component | Use when billing only the professional interpretation component separate from the technical lab work |
TC | Technical component | Use when billing only the technical component (laboratory processing) of the test |
52 | Reduced services | Use if a specimen or step in the test was partially performed reducing the service |
53 | Discontinued procedure | Use when the specimen collection or analytic process was begun but discontinued for specific clinical reasons |
59 | Distinct procedural service | Note: 59 is not in the provided list; therefore not included per strict rules |
QX | Ordering/servicing laboratory modifier — CLIA waived/point-of-care distinction | Use when applicable to designate the appropriate laboratory relationship per payer rules |
QY | Ordering/performing laboratory of service | Use to indicate the performing laboratory meets requirements to bill for testing |
AD | Physician assistant, certified nurse midwife, etc. | Use when the billing practitioner is a physician assistant or others covered by AD per payer guidance |
AS | Physician assistant in surgery | Use only when applicable for procedural oversight; rarely relevant to laboratory testing |
QK | Medical direction of two, three, or four ancillary personnel | Use when documenting medical direction of lab personnel for complex testing |
QY | Ordering/performing laboratory of service | Use to indicate the performing laboratory meets requirements to bill for testing |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Infectious Disease | Specialists order and interpret tenofovir levels for HIV management and adherence assessment |
| 207RG0100X | Hepatology | Clinicians managing chronic hepatitis B may order tenofovir monitoring for therapy adherence and toxicity |
| 208D00000X | Clinical Pathology | Laboratory medicine providers oversee LC–MS/MS assay performance and interpretation |
| 208000000X | Internal Medicine | Primary care and HIV-focused internists commonly order medication monitoring tests |
| 363LA2200X | Clinical Laboratory Technologist/Technician | Personnel performing specimen processing and LC–MS/MS testing |
Note: The modifier selection above focuses on the most clinically applicable modifiers for a reference laboratory PLA test; exact modifier use depends on payer policies and the billing scenario.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
B20 | Human immunodeficiency virus [HIV] disease | Tenofovir is a core antiretroviral; urine quantitation assesses adherence and exposure |
B18.1 | Chronic viral hepatitis B without delta-agent | Tenofovir is used for hepatitis B therapy; monitoring can assess adherence and toxicity risk |
N18.9 | Chronic kidney disease, unspecified | Renal impairment affects tenofovir clearance; levels guide toxicity risk assessment |
Z79.899 | Other long term (current) drug therapy | Documents ongoing antiretroviral therapy where monitoring of drug levels is relevant |
R53.81 | Other malaise | Nonspecific symptom prompting evaluation including drug toxicity assessment |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
81002 | Urinalysis, by dipstick or tablet reagent; non-automated, without microscopy | Often performed at point of care prior to sending urine for tenofovir quantitation to assess specimen quality |
36415 | Collection of venous blood by venipuncture | May be performed concurrently if serum testing (e.g., creatinine) is needed to evaluate renal function when interpreting tenofovir levels |
82570 | Drug assay, qualitative or semiquantitative, multiple drug classes; urine | May be used when broader urine drug screening is ordered in addition to specific tenofovir quantitation |
80053 | Comprehensive metabolic panel | Includes serum creatinine and electrolytes used to assess renal function relevant to tenofovir dosing and toxicity evaluation |
0042U | Tenofovir alafenamide quantitation, plasma or urine, LC–MS/MS (example PLA) | Other PLA drug quantitation codes for antiretroviral therapeutic drug monitoring; used in parallel when alternate formulations or matrices are tested |