Summary & Overview
CPT 0054U: AssuranceRx Micro Serum LC–MS/MS Prescription Drug Analysis
CPT code 0054U is a Proprietary Laboratory Analyses (PLA) code for the AssuranceRx Micro Serum assay by Firstox Laboratories, LLC. The test employs chromatography and tandem mass spectrometry (LC–MS/MS) on a capillary blood specimen to detect and quantify prescription medications. As a PLA code, 0054U identifies a single manufacturer-specific diagnostic assay and is used for billing when that specific test is performed.
This code matters nationally because laboratory PLA codes enable payers and providers to track utilization and cost for unique, manufacturer-specific diagnostics that traditional general lab CPT codes do not capture. Key payers analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers have varying policies for coverage of specialized pharmacologic and toxicology testing, which can influence access and reimbursement for assays like AssuranceRx Micro Serum.
Readers will learn the clinical context and service setting for CPT code 0054U, how PLA designations affect billing and tracking, and which national payers are relevant to reimbursement discussions. The publication also covers benchmarks, coding guidance, and policy considerations relevant to proprietary laboratory assays, offering a concise reference for coding, billing, and clinical teams evaluating or ordering this test.
Billing Code Overview
CPT code 0054U is a Proprietary Laboratory Analyses (PLA) code for the AssuranceRx Micro Serum test manufactured by Firstox Laboratories, LLC. The test uses chromatography and tandem mass spectrometry (LC–MS/MS) on a capillary blood specimen to determine the presence or absence and the quantity of prescription drug(s) in a patient’s body.
Service type: Laboratory testing — therapeutic drug monitoring / quantitative prescription drug analysis
Typical site of service: Clinical laboratory or specialty diagnostic laboratory using capillary blood collection (point-of-care collection or outpatient phlebotomy)
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Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an outpatient or ambulatory patient undergoing targeted therapeutic drug monitoring or medication adherence testing. A clinician (primary care physician, pain management specialist, addiction medicine clinician, or psychiatrist) orders the AssuranceRx Micro Serum test (0054U) for a patient prescribed controlled or high-risk medications (for example, opioids, benzodiazepines, certain psychiatric medications) to measure the presence and concentration of specified prescription drugs. A small capillary blood specimen is collected (fingerstick) in a clinic, urgent care, behavioral health clinic, or an outpatient laboratory. The specimen is sent to Firstox Laboratories, LLC for proprietary analysis using liquid chromatography–tandem mass spectrometry (LC–MS/MS). Results report presence/absence and quantitative levels of targeted prescription drugs to inform adherence assessment, dose adjustments, safety monitoring, or forensic/medico-legal review. Typical workflow: order placed by the treating clinician, capillary blood collection at point of care, specimen shipped per lab instructions, laboratory performs LC–MS/MS assay, and a report is returned to the ordering clinician for incorporation into clinical decision-making. The test may be performed at outpatient clinics, addiction treatment centers, pain clinics, psychiatric clinics, and independent reference laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; full service |