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 |