Summary & Overview
CPT 0031U: Cytochrome P450 1A2 Genotype, Mayo Clinic
CPT code 0031U designates a Proprietary Laboratory Analyses (PLA) test: the Cytochrome P450 1A2 Genotype developed by the Mayo Clinic. As a PLA code, it identifies a single, manufacturer- or laboratory-specific genetic assay that provides genotype information about the CYP1A2 enzyme, which can influence drug metabolism. Nationally, PLA codes like 0031U matter because they standardize billing for novel and proprietary molecular diagnostics, enabling clearer claims processing and payer evaluation for precision medicine services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find an explanation of what the code represents, the clinical context for a CYP1A2 genotype test, typical service setting and service type, and an outline of payer coverage considerations. The publication also summarizes available benchmarks and policy-relevant updates where provided, and highlights implications for clinical laboratories and billing workflows.
This executive summary presents the code’s purpose, its role in genetic testing reimbursement, and what stakeholders can expect to learn about billing classification, payer engagement, and operational impacts of adopting a PLA-coded laboratory assay.
Billing Code Overview
CPT code 0031U is a Proprietary Laboratory Analyses (PLA) code that describes a single, manufacturer- or laboratory-specific test: the Cytochrome P450 1A2 Genotype performed by the Mayo Clinic. The service type is a genetic/genomic laboratory test that reports genotype information for the CYP1A2 enzyme. The typical site of service is a clinical laboratory or reference laboratory setting where specialized molecular diagnostics are performed.
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Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with a history of variable response to caffeine and reports of adverse effects with certain antidepressants is referred by their primary care physician to precision medicine services at an academic medical center. The clinician orders the Cytochrome P450 1A2 genotyping test (0031U) to evaluate genetic variants affecting CYP1A2 enzyme activity. A phlebotomy appointment is scheduled at the hospital outpatient laboratory; a blood sample is collected using standard specimen handling and sent to the Mayo Clinic laboratory performing the proprietary test. Results reporting includes genotype (e.g., *1A/*1F) and inferred metabolizer status with a laboratory-provided interpretation. The ordering clinician integrates the genotype report into medication selection and dosing decisions for drugs metabolized primarily by CYP1A2 (for example certain antidepressants, antipsychotics, and stimulants) and documents the test result in the electronic health record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separate from the technical laboratory processing, if applicable. |
TC |