Summary & Overview
CPT 0038U: Sensieva Droplet 25‑OH Vitamin D2/D3 LC–MS/MS Assay
CPT code 0038U is a Proprietary Laboratory Analyses (PLA) code for the Sensieva Droplet™ 25 OH vitamin D2/D3 microvolume LC/MS assay by InSource Diagnostics. It designates a manufacturer-specific quantitative laboratory test that measures 25-hydroxyvitamin D2 and D3 from a very small serum sample using liquid chromatography-tandem mass spectrometry. PLA codes like 0038U matter nationally because they uniquely identify proprietary tests, support claims processing and tracking of novel diagnostics, and inform coverage decisions and pricing discussions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for vitamin D testing, the technical method (LC–MS/MS) and its implications for analytic specificity, and the role of microvolume assays in settings with limited specimen. The publication summarizes expected service settings (clinical and reference laboratories), common modifiers that may appear on claims, and available payer coverage patterns where present. It also highlights benchmarking and policy considerations relevant to PLA-coded tests, including implications for coding consistency, claim adjudication, and national reporting.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line is noted where applicable.
Billing Code Overview
CPT code 0038U is a Proprietary Laboratory Analyses (PLA) code that describes a single, manufacturer-specific laboratory test. The code identifies the Sensieva Droplet™ 25 OH vitamin D2/D3 microvolume LC/MS assay from InSource Diagnostics, a quantitative serum test for vitamin D (25-hydroxyvitamin D2 and D3) performed using liquid chromatography with tandem mass spectrometry (LC–MS/MS).
Service Type: Laboratory — quantitative LC–MS/MS assay for 25‑hydroxyvitamin D2/D3
Typical Site of Service: Clinical laboratory or reference laboratory using microvolume serum samples
Clinical & Coding Specifications
Clinical Context
A typical patient for the 0038U Sensieva Droplet™ 25 OH vitamin D2/D3 microvolume LC/MS assay is an outpatient or inpatient whose provider needs an accurate quantitative measurement of serum 25-hydroxyvitamin D2 and D3 from a very small blood volume. Common scenarios include: monitoring vitamin D status in infants and children with limited blood volume, tracking vitamin D therapy in patients with malabsorption or gastric bypass, evaluating hypocalcemia or metabolic bone disease, or confirming insufficiency/deficiency when immunoassay results are equivocal. The clinical workflow: a clinician orders 0038U on the laboratory requisition, a phlebotomist collects a microvolume serum sample (often from a capillary or small-volume venipuncture), the specimen is sent to the laboratory performing the proprietary LC–MS/MS assay, results are reported to the ordering provider, and the provider uses quantitative D2 and D3 results for diagnosis, monitoring therapy, or treatment planning. Typical sites of service include hospital outpatient laboratories, independent reference laboratories, specialty clinical laboratories, and neonatal or pediatric inpatient units where microvolume sampling is required.
Coding Specifications
- Below are the most clinically relevant modifiers for
0038Uwith usage guidance.
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component (interpretation/oversight) separate from the technical laboratory processing, if applicable and permitted. |
TC | Technical component | Use when billing only the technical component (laboratory processing and testing) of the assay. |
59 | Data not available in the input. | Data not available in the input. |
52 | Reduced services | Use when the test is performed but services are partially reduced (for example, insufficient volume leads to partial panel reporting) and payer accepts modifier 52 for laboratory tests. |
53 | Discontinued procedure | Use when specimen collection or testing was started but discontinued for documented clinical reasons before completion. |
76 | Data not available in the input. | Data not available in the input. |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Generally not applicable to this laboratory test; included in raw list but not typically used. |
80 | Data not available in the input. | Data not available in the input. |
22 | Increased procedural services | Use when the laboratory documents that the assay required substantially greater resources (rare for standardized PLA test; requires documentation and payer approval). |
23 | Unusual anesthesia | Not applicable for 0038U; included in raw list but not typically used. |
62 | Two surgeons | Not applicable for this lab procedure. |
11 | Data not available in the input. | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Pathology & Laboratory Medicine | Clinical pathologists oversee laboratory testing and result validation. |
| 207K00000X | Clinical Laboratory | Clinical laboratory directors and supervisors manage testing operations and QA for LC–MS/MS assays. |
| 208000000X | Pediatrics | Pediatricians commonly order microvolume vitamin D tests for infants and children. |
| 363L00000X | Phlebotomy | Phlebotomists skilled in microvolume collection perform sample acquisition. |
Related Diagnoses
- Frequently associated clinical diagnoses for ordering quantitative 25-hydroxyvitamin D2/D3 testing.
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E55.9 | Vitamin D deficiency, unspecified | Primary indication for measuring serum 25-hydroxyvitamin D to confirm deficiency. |
E83.51 | Hypocalcemia | Vitamin D status is evaluated when hypocalcemia is present because deficiency can cause low calcium. |
M81.0 | Age-related osteoporosis without current pathological fracture | Vitamin D testing is part of metabolic evaluation in osteoporosis management. |
K90.0 | Celiac disease | Malabsorption disorders like celiac disease can cause vitamin D deficiency; monitoring is indicated. |
Z13.820 | Encounter for screening for osteoporosis | Vitamin D measurement may be ordered during osteoporosis screening or risk assessment. |
Related CPT Codes
- Common CPT codes performed alongside or in the workflow with
0038U.
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Used to collect the serum specimen for the vitamin D assay when venous microvolume collection is required. |
99495 | Data not available in the input. | Data not available in the input. |
80048 | Basic metabolic panel | Performed concurrently in patients being evaluated for metabolic or electrolyte abnormalities alongside vitamin D testing. |
82043 | Assay of 25-hydroxyvitamin D; immunoassay | Alternative method; may be ordered when LC–MS/MS is not available or as a comparative assay. |
83520 | Assay of 25-hydroxyvitamin D; mass spectrometry | Related technical methodology; labs may bill a mass spectrometry vitamin D assay when not using the PLA 0038U specific test. |