Summary & Overview
CPT 0030U: Warfarin Response Genotype Assay
CPT code 0030U denotes a Proprietary Laboratory Analyses (PLA) test: the Mayo Clinic’s Warfarin Response Genotype assay. As a PLA code, it identifies one unique commercial laboratory test rather than a class of assays. Genotype-guided warfarin management has implications for patient safety and anticoagulation dosing precision, so accurate coding and payer recognition are important for claims processing nationally.
Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the code’s clinical purpose, typical site of service, and the context for billing and reimbursement review. The publication provides national benchmarks where available, a summary of payer coverage considerations, and clinical context on why a warfarin response genotype matters for personalized anticoagulation therapy.
This resource is written for health payers, billing specialists, laboratory administrators, and clinicians seeking an authoritative summary of CPT code 0030U, its clinical role, and the typical payer landscape. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 0030U is a Proprietary Laboratory Analyses (PLA) code that describes a single, specific laboratory test: the Warfarin Response Genotype assay developed by the Mayo Clinic. This test reports genetic information relevant to patient response to warfarin therapy.
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Service type: Genetic testing / pharmacogenomic laboratory assay
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Typical site of service: Clinical laboratory or hospital laboratory performing proprietary molecular diagnostics
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with non-valvular atrial fibrillation is evaluated by a cardiology clinic prior to initiating warfarin therapy. The clinician orders the 0030U Warfarin Response Genotype test from the Mayo Clinic to assess genetic variants (e.g., CYP2C9 and VKORC1) that affect warfarin metabolism and sensitivity. A peripheral blood draw or buccal swab specimen is collected in the outpatient lab or clinic; the specimen is shipped to the Mayo Clinic reference laboratory. Results are returned to the ordering clinician and integrated into the electronic health record to guide initial dosing and anticipated monitoring frequency. Typical sites of service include outpatient physician offices, hospital outpatient laboratories, and independent clinical laboratories. The workflow includes order placement, consent as required by institutional policy, specimen collection, courier shipment, result reporting, and clinician interpretation documented in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation portion if applicable and the laboratory separates technical and professional components. |
TC |