Summary & Overview
CPT 0064U: Syphilis Total & RPR Immunoassay Panel
CPT code 0064U is a Proprietary Laboratory Analyses (PLA) CPT code for the BioPlex™ 2200 Syphilis Total & RPR Assay, a single immunoassay panel that measures total treponemal antibody and non-treponemal rapid plasma reagin (RPR) antibody to support syphilis diagnosis and treatment management. PLA codes like 0064U identify manufacturer‑ or lab‑specific tests and matter nationally because they affect laboratory billing transparency, payer coverage decisions, and the integration of novel diagnostics into clinical pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a compact review of what 0064U represents clinically, the typical site of service, and which payers commonly evaluate coverage for PLA laboratory tests. The publication outlines benchmarks and policy-relevant considerations such as PLA code implications for claims processing, how payers may apply coverage criteria for proprietary syphilis assays, and typical billing contexts in which 0064U appears. Clinical context on the assay’s dual treponemal and non‑treponemal targets is included to clarify when the test is used in diagnosis and treatment monitoring.
Data not available in the input includes specific payer coverage policies, reimbursement rates, detailed denial patterns, associated taxonomies, and ICD-10 diagnosis pairings.
Billing Code Overview
CPT code 0064U is a Proprietary Laboratory Analyses (PLA) code for the BioPlex™ 2200 Syphilis Total & RPR Assay from Bio–Rad® Laboratories. This single immunoassay panel evaluates both total treponemal antibody and non-treponemal rapid plasma reagin (RPR) antibody in a patient specimen to aid in syphilis diagnosis or treatment management.
Service Type: Laboratory—serologic infectious disease testing (syphilis panel)
Typical Site of Service: Clinical laboratory or reference laboratory performing diagnostic serologic testing.
Clinical & Coding Specifications
Clinical Context
A 28-year-old sexually active patient presents to an outpatient community sexual health clinic with concerns of recent high-risk exposure and new genital lesions. The clinician obtains a sexual history, performs a focused physical exam, and orders laboratory testing for sexually transmitted infections. The clinic collects a serum specimen and submits it to the on-site or reference laboratory for the BioPlex™ 2200 Syphilis Total & RPR Assay. The test performs a single immunoassay panel that simultaneously evaluates total treponemal antibodies and non-treponemal rapid plasma reagin (RPR) reactivity to aid in the diagnosis of syphilis or to monitor treatment response. Typical workflow steps: sample collection, specimen labeling, laboratory accessioning, automated running of the BioPlex™ 2200 instrument, result verification by laboratory personnel, and electronic reporting of combined treponemal and non-treponemal results to the ordering clinician for interpretation and treatment planning. Typical sites of service include outpatient clinics, public health/STI clinics, physician offices, and clinical laboratories. The service type is a laboratory diagnostic assay (Proprietary Laboratory Analyses).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Placeholder for standard reporting | Use when no specific modifier applies and the payer requires explicit reporting of baseline modifier; generally not used clinically. |
| 11 | Professional component | Use when only the professional component (interpretation) of a combined service is reported by the performing physician or lab professional. |