Summary & Overview
CPT 0068U: MycoDART–PCR Dual Amplification Real-Time PCR Panel for 6 Candida Species
CPT code 0068U is a Proprietary Laboratory Analyses (PLA) code for the MycoDART–PCR™ Dual Amplification Real–Time PCR panel that identifies six Candida species from patient specimens such as blood. PLA codes are single-source, manufacturer-specific codes used to track and bill for novel or proprietary laboratory tests. Nationally, PLA codes like 0068U matter because they capture advanced molecular diagnostics that affect infectious disease detection, antimicrobial stewardship, and hospital laboratory workflows.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage considerations and benchmarking context for molecular infectious disease testing using PLA codes.
Readers will learn what CPT code 0068U represents clinically, the typical service setting for the assay, and the scope of its use for rapid detection of Candida species. The article summarizes payer coverage landscape at a national level, discusses policy and billing implications tied to PLA codes, and provides clinical context about when a rapid Candida PCR panel may be used in patient care pathways. Data not provided in the input (such as specific payer policies, reimbursement rates, or related taxonomies) is noted as unavailable.
Billing Code Overview
CPT code 0068U is a Proprietary Laboratory Analyses (PLA) code for the MycoDART–PCR™ Dual Amplification Real–Time PCR panel that detects six distinct Candida species. The test is a rapid, amplified probe assay intended to detect or rule out Candida species in patient specimens such as blood. This code applies to a single, manufacturer-specific laboratory test produced by RealTime Laboratories/MycoDART Inc.
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Service type: Laboratory diagnostic test — rapid amplified probe real-time PCR for pathogen identification
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Typical site of service: Clinical laboratory or hospital laboratory processing patient specimens (for example, blood)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A hospitalized adult with suspected candidemia is evaluated when blood cultures remain negative but clinical signs persist (fever, hypotension, leukocytosis) or when rapid species identification is needed to tailor antifungal therapy. A central line–associated bloodstream infection is suspected in an intensive care unit patient with sepsis after broad-spectrum antibacterial therapy; the clinician orders a rapid molecular fungal panel on a blood specimen to detect or rule out six Candida species. The workflow: the clinician places an order for the MycoDART–PCR™ Dual Amplification Real–Time PCR panel (0068U), phlebotomy obtains a timed blood draw (paired peripheral and catheter cultures if indicated), the specimen is sent to the performing laboratory (on-site hospital molecular lab or reference lab), the lab performs nucleic acid extraction and real‑time PCR amplification, technical review and analytic validation occur, and the result (species detected or not detected) is reported to the ordering provider to inform antifungal selection and infection control actions. Typical site of service is hospital inpatient (ICU or ward) or hospital outpatient infusion/ED settings; the service type is laboratory molecular diagnostic testing performed by a qualified clinical laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure performed as billed (no modifier) | Rarely appended; use if payer requires explicit native state modifier for system use |
11 | Professional component only | When only the physician's interpretive professional component is reported separate from the lab technical component |
26 | Professional component | When a physician or qualified clinician bills for interpretation or consultative report distinct from the laboratory |
52 | Reduced services | When specimen collection or testing is partially reduced (e.g., limited panel run due to specimen insufficiency) |
53 | Discontinued procedure | When testing is started but abandoned for valid medical reasons prior to completion |
59 | Distinct procedural service | Not in provided list; omitted per input constraints |
62 | Two surgeons/dual operator | Use only if two independent practitioners jointly perform an uncommon laboratory procedure requiring dual oversight (rare) |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure | Not typically applicable to lab testing; included rarely when tied to specimen collection in OR setting |
80 | Assistant surgeon | Not applicable to laboratory testing; use rarely if a separate assistant physician performs component tasks |
AD | Medical supervision by a physician: more than four concurrent anesthesia cases | Not applicable to this lab test |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Infectious Disease | Ordering and interpreting clinicians for complex candidemia cases |
207RH0000X | Hospitalist | Frequent inpatient ordering provider for sepsis and bloodstream infection workup |
207L00000X | Pathology & Clinical Laboratory | Laboratory directors and pathologists overseeing molecular diagnostics |
208D00000X | Critical Care Medicine | ICU physicians ordering rapid fungal diagnostics for unstable patients |
364S00000X | Phlebotomy/Lab Technician | Personnel who perform specimen collection and processing |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
B37.7 | Candidal sepsis | Direct indication for rapid Candida species testing in bloodstream infections |
B37.3 | Candidiasis of vulva and vagina | Not a primary indication for blood-based molecular Candida panel but relevant to broader Candida disease spectrum |
A41.9 | Sepsis, unspecified organism | Empiric molecular testing is used when sepsis etiology is unknown and fungal cause is suspected |
T80.7XXA | Infection following infusion, initial encounter | Post‑infusion sepsis workup may include rapid Candida species testing |
R65.20 | Severe sepsis without septic shock | Supports use of expedited diagnostics including molecular panels for bloodstream pathogens |
T82.7XXA | Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter | Device-related bloodstream infections may prompt Candida molecular testing |
Z20.828 | Contact with and (suspected) exposure to other viral communicable diseases | Not specific to Candida; included sparingly when fungal exposure risk is evaluated |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87077 | Culture, bacterial; any source, aerobic, with isolation and presumptive identification of isolates | May be ordered alongside molecular testing for culture-based organism recovery and susceptibility testing |
87471 | Infectious agent detection by nucleic acid (DNA or RNA); Candida species, multiplex, amplified probe technique, multiple organisms | Alternate or related molecular detection codes for Candida panels when not using a PLA code |
87070 | Culture, bacterial; any other source, isolation and presumptive identification | Used for sterile site cultures (blood) performed in parallel with molecular testing |
86328 | Immunoassay for infectious agents (qualitative or semiquantitative), e.g., fungal antigen testing | Complementary tests such as beta-D-glucan or fungal antigen assays may be ordered with 0068U to support diagnosis |
36415 | Collection of venous blood by venipuncture | Specimen collection typically performed before molecular testing; billed by qualified ancillary staff if separately payable |