Summary & Overview
CPT 0036U: EXaCT–1 Whole Exome Sequencing (WES)
CPT code 0036U designates EXaCT–1 whole exome sequencing (WES), a Proprietary Laboratory Analyses (PLA) molecular assay performed by the Lab of Oncology–Molecular Detection at Weill Cornell Medicine–Clinical Genomics Laboratory. As a PLA code, 0036U identifies a single, manufacturer- or laboratory-specific test that sequences the protein-coding regions of the genome, supporting diagnostic evaluation and genomic characterization in oncology and other clinical contexts. Nationally, PLA codes like 0036U matter because they represent lab-developed or proprietary tests with unique clinical utility and distinct coding and coverage considerations compared with generic or bundled genomic tests.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of the code’s clinical scope, how the service is typically delivered, and the payer landscape addressed. The publication presents benchmarks where available, notes relevant policy and coverage considerations for proprietary molecular assays, and provides clinical context for WES utilization in specialty care. Data not provided in the input—such as specific coverage policies, reimbursement rates, associated taxonomies, ICD-10 pairings, and related codes—are identified as unavailable.
Billing Code Overview
CPT code 0036U is a Proprietary Laboratory Analyses (PLA) code that describes the EXaCT–1 whole exome testing performed by the Lab of Oncology–Molecular Detection, Weill Cornell Medicine–Clinical Genomics Laboratory. The test is a molecular assay that sequences the functional coding regions (exons) of the genome and is used for whole exome sequencing (WES).
Service type: Molecular diagnostic testing — whole exome sequencing (WES)
Typical site of service: Clinical molecular diagnostics laboratory; may be ordered in outpatient or inpatient clinical settings with specimen processing performed in a specialized laboratory
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual with a suspected genetic disorder unexplained by prior targeted testing, recurrent undiagnosed multisystem findings, or a cancer patient whose tumor or germline status requires comprehensive protein-coding region sequencing. The clinician (geneticist, oncologist, or pediatric neurologist) documents medical necessity and orders the EXaCT–1 whole exome sequencing (0036U) from the Lab of Oncology–Molecular Detection, Weill Cornell Medicine–Clinical Genomics Laboratory. The clinical workflow includes: pre-test counseling and consent, blood or saliva specimen collection at an outpatient clinic or hospital phlebotomy service, specimen shipment to the laboratory, laboratory processing with exome capture and high-throughput sequencing, bioinformatic variant calling and annotation, clinical interpretation by laboratory molecular pathologists/geneticists, and issuance of a clinical report. Post-test, the ordering clinician reviews results with the patient and documents the clinical impact on diagnosis, prognosis, or treatment selection. Typical site of service is outpatient clinics, hospital outpatient departments, or specialty genetics centers. Specimens may be collected in ambulatory phlebotomy, inpatient bedsides, or ambulatory surgery centers when relevant.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default, no modifier | Rarely used on claims; indicates no special reporting modifier is appended |