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.