Summary & Overview
CPT 0026U: ThyroSeq® v3 Thyroid Molecular Test
CPT code 0026U is a Proprietary Laboratory Analyses (PLA) code that identifies ThyroSeq® version 3, a laboratory-specific molecular diagnostic assay for evaluation of thyroid nodules. As a PLA code, 0026U is tied to a unique test made by a specific developer and is used to distinguish this proprietary genomic assay in billing and coverage discussions. Nationally, PLA codes matter because they allow payers, providers, and labs to track and manage utilization and reimbursement for novel laboratory-developed tests.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the payers commonly engaged in coverage and reimbursement for laboratory molecular diagnostics. The analysis also highlights common modifiers used with laboratory billing and identifies where data was not available in the input.
This publication provides benchmarks and policy-relevant information useful for billing staff, laboratory managers, and policy analysts: recognition of the PLA designation and its implications for tracking test use, the expected clinical application for thyroid nodule evaluation, and payer coverage landscape at a national level. Data not available in the input includes specific associated taxonomies, ICD-10 diagnoses, related codes, and service line detail beyond the laboratory context.
Billing Code Overview
CPT code 0026U is a Proprietary Laboratory Analyses (PLA) code that describes ThyroSeq® version 3, a targeted molecular test developed at the University of Pittsburgh Medical Center for CBLPath, Inc. The code denotes a single, manufacturer- or laboratory-specific genomic assay used for analysis of thyroid nodules and related specimens.
Service Type: Proprietary laboratory molecular diagnostic test
Typical Site of Service: Clinical laboratory or reference laboratory
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to an endocrinology clinic after a thyroid nodule is identified on neck ultrasound. Fine-needle aspiration (FNA) cytology returns an indeterminate result (e.g., Bethesda III or IV). The endocrinologist orders molecular testing using the ThyroSeq® v3 assay to better stratify malignancy risk and inform surgical decision-making. A clinic staff member collects the FNA sample or reserves previously collected cytology material, prepares and ships the specimen to the performing laboratory (CBLPath, Inc.), and documents specimen type, collection date, and relevant clinical history in the requisition. The laboratory performs the proprietary genomic panel analysis described by PLA code 0026U, generates a report with mutation and gene-fusion findings, and returns actionable risk assessment to the ordering clinician. Typical sites of service include hospital outpatient departments, freestanding ambulatory surgery centers, outpatient clinics (endocrinology or otolaryngology), and reference laboratories that perform PLA testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified claim | Use when no specific modifier is applicable for the service. |
11 |