Summary & Overview
CPT 0072U: CYP2D6–2D7 Hybrid Gene Targeted Sequence Analysis
CPT code 0072U denotes a Proprietary Laboratory Analyses (PLA) molecular diagnostic test: the CYP2D6–2D7 Hybrid Gene Targeted Sequence Analysis developed by the Mayo Clinic Laboratory. It is intended as a reflex or follow-up assay when the initial PLA test 0070U fails to establish a patient’s CYP2D6 genotype. Determination of CYP2D6 genotype has national relevance because it can influence drug metabolism and therapeutic decisions for medications processed by the CYP2D6 enzyme pathway.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical role of the assay, site-of-service considerations for laboratory-based molecular testing, and payer relevance. The publication provides benchmarks and coverage context, summarizes policy and coding implications for a PLA-designated code, and outlines clinical scenarios in which a follow-up targeted sequence analysis is used. It also highlights common billing modifiers and notes when data elements are unavailable.
This summary is intended for a national audience of coding professionals, laboratory managers, and policy analysts seeking a concise reference on the clinical purpose, payer scope, and billing context for CPT code 0072U.
Billing Code Overview
CPT code 0072U is a Proprietary Laboratory Analyses (PLA) code for the CYP2D6–2D7 Hybrid Gene Targeted Sequence Analysis, developed by the Mayo Clinic Laboratory. This test is a follow-up molecular diagnostic assay used when the initial 0070U test does not determine a patient’s CYP2D6 genotype, which can affect metabolism of certain medications.
Service type: Molecular diagnostic genetic testing / targeted gene sequence analysis
Typical site of service: Clinical laboratory or specialized molecular diagnostics laboratory
Clinical & Coding Specifications
Clinical Context
A patient is referred for targeted genetic analysis after an initial pharmacogenomic assay yields an inconclusive CYP2D6 result. The patient is typically an adult or pediatric patient taking or being considered for medications metabolized by CYP2D6 (for example, certain antidepressants, opioids, beta-blockers, or tamoxifen) where genotype-directed prescribing may affect safety or efficacy. A clinician (often a clinical pharmacologist, psychiatrist, oncologist, pain specialist, or primary care provider) orders the follow‑up test 0072U to resolve a suspected CYP2D6–2D7 hybrid allele that interfered with the initial genotype call.
Workflow:
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The ordering clinician documents indication and relevant medications in the chart and sends a specimen (usually blood or saliva) to the performing laboratory.
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The laboratory receives the specimen, verifies patient identifiers, and performs targeted sequence analysis using the proprietary Mayo Clinic Laboratory method specifically described by
0072Uto detect CYP2D6–2D7 hybrid alleles. -
The laboratory interprets results and issues a report that clarifies the CYP2D6 genotype/allele status, including presence or absence of hybrid alleles and predicted metabolizer phenotype.
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The ordering clinician reviews the report and incorporates the clarified genotype into medication selection or dosing decisions and documents the pharmacogenomic result in the EHR with problem list or medication reconciliation notes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Modifier not used in CMS standard; placeholder | Data not available in the input. |
11 | Professional component | Attach when billing only the professional component (interpretation) of the laboratory test if local payer accepts.
26 | Professional component | Use when only the physician interpretation/reporting portion is billed separately from the technical lab work.
TC | Technical component | Use when billing only the technical component (laboratory processing) of the test.
52 | Reduced services | Apply when the test was partially reduced or not fully performed but a report is still issued.
53 | Discontinued procedure | Use if specimen received but testing discontinued for documented clinical reasons.
78 | Unplanned return to the operating/procedure room by same physician following initial procedure | Rare for lab tests; generally not applicable clinically.
80 | Assistant surgeon | Not applicable to laboratory testing; included in input list but typically unused for 0072U.
82 | Assistant surgeon (when qualified resident unavailable) | Not applicable to laboratory testing.
QK | Medical direction of two, three, or four technicians/therapists | Not applicable to lab PLA codes; included for completeness.
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080P0206X | Clinical Pathology | Clinical pathologists or molecular genetic pathologists interpret complex pharmacogenomic sequencing tests. |
207RH0000X | Clinical Molecular Genetics | Molecular geneticists or laboratory physicians who oversee sequencing and analysis workflows.
207L00000X | Diagnostic Molecular Laboratory | Laboratory specialists responsible for running and validating proprietary PLA assays.
208D00000X | Pharmacology | Clinical pharmacologists who order and apply pharmacogenomic results to drug therapy.
207Q00000X | Psychiatry | Psychiatrists commonly order CYP2D6 testing to guide antidepressant and antipsychotic prescribing.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z13.79 | Encounter for other screening for genetic and chromosomal anomalies | Appropriate for asymptomatic pharmacogenomic screening or population-based drug-gene testing. |
R79.89 | Other specified abnormal findings of blood chemistry | May be used if abnormal laboratory findings prompt pharmacogenomic follow-up when interpreting medication-related metabolism concerns.
F32.9 | Major depressive disorder, single episode, unspecified | Common indication for CYP2D6 testing to guide antidepressant therapy.
G89.3 | Neoplasm related pain (acute and chronic) | Opioid therapy considerations; CYP2D6 genotype affects opioid metabolism (e.g., codeine, tramadol).
C50.911 | Malignant neoplasm of unspecified site of right female breast | Example oncology indication where tamoxifen efficacy is influenced by CYP2D6 metabolizer status.
I10 | Essential (primary) hypertension | Certain beta-blockers are metabolized by CYP2D6; genotype may inform drug selection/dosing.
Z79.899 | Other long term (current) drug therapy | Indicates patients on chronic medications where pharmacogenomic testing may impact therapy.
T88.7XXA | Unspecified adverse effect of drug or medicament, initial encounter | Used when adverse drug reaction prompts CYP2D6 genotyping to explain atypical metabolism.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
0070U | CYP2D6 Gene Targeted Sequence Analysis (initial assay) | Initial pharmacogenomic assay; 0072U is a follow‑up when 0070U is inconclusive for CYP2D6 genotype due to possible hybrid alleles. |
81225 | CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) gene analysis, common variants (eg, *2, *3, *4, *5, *6), single or multiple variants; genotyping by targeted sequence analysis | Commonly used CYP2D6 genotyping code for targeted variant panels; may be used before or instead of PLA codes depending on laboratory methods.
81479 | Unlisted molecular pathology procedure | Used in workflows when a specific PLA code is not available, or for custom molecular testing adjuncts to targeted sequence analysis.
88360 | Immunohistochemistry or special stains interpreted by a pathologist (qualitative or semiquantitative) | Not directly related but appears in some molecular pathology workflows when tissue-based ancillary studies are required.
G0452 | Pharmacogenetic testing, multiple gene analysis (list separately in addition to primary test) | Applicable in broader pharmacogenomic panels where CYP2D6 testing is part of multi-gene reports.