CPT 0074U: CYP2D6 Trans‑duplication/Multiplication Targeted Sequence Analysis - OpenPayer

Beta

OpenPayer Beta

Summary & Overview

CPT 0074U: CYP2D6 Trans‑duplication/Multiplication Targeted Sequence Analysis

CPT code 0074U designates a proprietary laboratory assay for CYP2D6 trans–duplication/multiplication non–duplicated gene targeted sequence analysis developed by the Mayo Clinic Laboratory. As a PLA follow-up test to 0070U, it is used when standard testing fails to determine a patient’s CYP2D6 genotype, which can influence metabolism and dosing considerations for multiple medications. Nationally, targeted pharmacogenomic testing like this supports precision medicine and can impact prescribing decisions across specialties that manage drugs metabolized by CYP2D6.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose and lab setting for the test, payer coverage context, and what to expect in benchmark and policy content. The publication addresses billing and reporting specifics for a PLA code, payer alignment and common modifier usage, and clinical context linking CYP2D6 genotype resolution to therapeutic implications. Where input data is missing, the report notes that specific taxonomies, ICD-10 mappings, and related codes are not available in the source.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0074UCPTproprietary laboratory analysispharmacogenomicsCYP2D6genetic testinglaboratorytargeted sequence analysis

Billing Code Overview

CPT code 0074U is a Proprietary Laboratory Analyses (PLA) code for the CYP2D6 trans–duplication/multiplication non–duplicated gene targeted sequence analysis developed by the Mayo Clinic Laboratory. This test is a follow-up genetic sequencing assay performed when the initial 0070U test does not determine a patient’s CYP2D6 genotype. The result can affect drug metabolism interpretation for medications metabolized by CYP2D6.

Service type: Genetic diagnostic laboratory test (proprietary targeted sequence analysis)
Typical site of service: Clinical or reference laboratory setting (specimen collected in outpatient or inpatient settings and analyzed at the performing laboratory)

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A patient referred for pharmacogenetic clarification after initial CYP2D6 testing returned an inconclusive genotype due to suspected copy number variation. The patient is an adult receiving multiple medications metabolized by CYP2D6 (for example, selective serotonin reuptake inhibitors, tricyclic antidepressants, certain opioids, or tamoxifen). The treating clinician (primary care physician, psychiatrist, pain specialist, or oncologist) orders a follow-up targeted assay to resolve gene duplications/multiplications versus non-duplicated alleles. A blood or buccal specimen is collected in an outpatient laboratory or hospital clinical laboratory. The sample is sent to the Mayo Clinic Laboratory for the proprietary test reported with 0074U. Results clarify CYP2D6 allele copy number and inform phenotype assignment (ultrarapid, normal, intermediate, poor metabolizer) which can impact drug selection or dosing. Typical site of service is a hospital-based or independent clinical laboratory, with specimen collection in an outpatient clinic, ambulatory surgery center, or inpatient setting when needed. Documentation in the medical record includes the indication, prior 0070U result showing unresolved genotype, specimen type, and the clinical reason for repeat testing (medication management, adverse reaction history, or treatment optimization).

Coding Specifications

Modifier	Description	When to Use
`00`

Taxonomy Code	Specialty	Notes
`207Q00000X`	Clinical Laboratory Molecular Pathology	Laboratories or specialists performing molecular genetic testing and interpretation.
`207K00000X`	Clinical Laboratory	Hospital or independent clinical laboratories performing high-complexity testing.
`2084P0800X`	Medical Oncology	Oncologists who may order pharmacogenetic testing for drug metabolism implications (e.g., tamoxifen).
`2084N0400X`	Pain Medicine	Pain specialists managing opioids metabolized by CYP2D6 who order genotype clarification.
`208M00000X`	Psychiatry	Psychiatrists managing antidepressant therapy impacted by CYP2D6 phenotype.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z13.79`	Encounter for other genetic screening	Indicates testing ordered for pharmacogenetic screening or clarification when prior testing was inconclusive.
`Z15.09`	Genetic susceptibility to other disease, carrier of other specified genetic disease	Used when documenting genetic susceptibility relevant to drug response.
`F32.9`	Major depressive disorder, single episode, unspecified	Depression treated with medications metabolized by CYP2D6 where genotype affects drug selection/dosing.
`G89.4`	Chronic pain syndrome	Pain management using opioids influenced by CYP2D6 metabolism; genotype may guide therapy.
`C79.9`	Secondary malignant neoplasm of unspecified site	Oncology patients on drugs like tamoxifen where CYP2D6 activity affects efficacy and testing may be ordered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0070U`	CYP2D6 non-duplicated gene targeted sequence analysis (initial test)	Performed prior to `0074U`; `0074U` is a follow-up when `0070U` does not define genotype due to copy number uncertainty.
`81323`	CYP2D6 (eg, for phenotype prediction) gene analysis, common variants, multiple exons	Alternative or complementary CYP2D6 testing used by some laboratories for genotype/phenotype prediction.
`81162`	CPT code for targeted sequence analysis of a single gene (example: duplicated allele analysis)	Used for certain targeted gene assays; may be part of workflow in labs without a PLA code.
`88271`	Flow cytometry, DNA analysis (example)	Not typical for CYP2D6 sequencing but may be used in specialized workflows for copy number assessment in research settings.
`0033U`	Pharmacogenomic panel, specific proprietary test (example)	Other PLA codes or proprietary pharmacogenomic assays that may be ordered alongside CYP2D6 testing for broader medication management.