Summary & Overview
CPT 0047U: Genomic Prostate Score (GPS) Test
CPT code 0047U identifies the Genomic Prostate Score® (GPS) Test from MDxHealth Inc., a proprietary molecular diagnostic assay that uses RT–PCR to profile mRNA expression of 17 genes and combines results with patient data in an algorithm to estimate mortality and postprostatectomy recurrence risk. As a PLA code, 0047U applies to a single manufacturer's unique test, making it significant for coding, laboratory billing, and payer coverage policies nationally. Commercial and public payers have distinct approaches to molecular diagnostic PLA codes, so clarity on coding and clinical utility affects access and reimbursement for genomic-guided prostate cancer care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise synthesis of what 0047U represents clinically, typical sites of service, and the commercial and Medicare payer landscape as covered in this analysis. The publication summarizes coverage themes, common billing modifiers and operational considerations, and clinical context for use of the GPS test in prostate cancer risk stratification. It also highlights where input data was not provided: associated taxonomies, ICD-10 diagnoses, related codes, and specific payer policy details are noted as unavailable in the input.
Billing Code Overview
CPT code 0047U is a Proprietary Laboratory Analyses (PLA) code for the Genomic Prostate Score® (GPS) Test from MDxHealth Inc. The test uses real–time polymerase chain reaction (RT–PCR) to measure mRNA expression for 17 genes and combines those results with patient data in a proprietary algorithm to generate a genomic score that helps predict mortality risk and risk of postprostatectomy recurrence.
Service Type: Laboratory — molecular diagnostic, gene expression profiling
Typical Site of Service: Clinical laboratory or reference laboratory (specimen collected in outpatient or ambulatory settings and sent to the performing laboratory)
Clinical & Coding Specifications
Clinical Context
A typical patient is a man diagnosed with clinically localized prostate cancer or an elevated prostate‑specific antigen (PSA) with biopsy-proven prostate adenocarcinoma who and his treating urologist or oncologist is evaluating individualized postoperative or treatment decision-making. The Genomic Prostate Score® (GPS) Test 0047U is ordered after diagnostic prostate needle biopsy or at time of prostatectomy tissue availability to assess mRNA expression of 17 genes by real‑time PCR and integrate results with clinical features. The workflow: the clinician obtains informed consent, submits formalin‑fixed paraffin‑embedded (FFPE) biopsy or prostatectomy tissue and relevant clinical data to the testing laboratory; the lab performs RNA extraction, RT‑PCR expression profiling and applies the proprietary algorithm to generate a GPS result; the laboratory reports the score to the ordering provider, who uses the score alongside PSA, Gleason grade group, tumor stage and patient preferences to inform prognosis and decisions about active surveillance, definitive therapy intensification, or adjuvant treatment consideration. Typical site of service is an independent or hospital-based clinical molecular pathology laboratory performing the high-complexity molecular test; specimen collection occurs in an ambulatory surgery center, outpatient clinic, or hospital operating room for biopsy or prostatectomy, with the laboratory component reported using 0047U.
Coding Specifications
| Modifier | Description | When to Use |
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