CPT 0080U: BDX–XL2 Blood Plasma Lung Nodule Risk Assay - OpenPayer

Summary & Overview

CPT 0080U: BDX–XL2 Blood Plasma Lung Nodule Risk Assay

CPT code 0080U designates the BDX–XL2 proprietary laboratory test from Biodesix®, Inc., a blood-plasma based biomarker assay that measures two proteins and integrates those results with five clinical risk factors to estimate the probability that a pulmonary nodule is benign or malignant. As a PLA code, 0080U applies only to this specific manufacturer’s test, which frames coverage and billing as test-specific rather than modality-wide. Nationally, proprietary assays like 0080U are significant because they influence diagnostic pathways for pulmonary nodules, potentially affecting downstream imaging, biopsy, and specialist referral volumes.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what 0080U represents, typical sites of service, and the clinical context for use in lung nodule risk assessment. The publication also summarizes common billing modifiers and practical considerations for submitting claims for a PLA test, and outlines where to look for payer coverage policies and reimbursement updates. Where input data is incomplete, the report notes "Data not available in the input." The content is designed to inform billing professionals, laboratory managers, and policy analysts about coding precision, payer scope, and clinical utility implications tied to CPT code 0080U.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0080UCPTProprietary Laboratory AnalysisBDX-XL2lung nodule riskbiomarker assayclinical laboratorydiagnostic testing

Billing Code Overview

CPT code 0080U is a Proprietary Laboratory Analyses (PLA) code specific to a single commercial test. Report 0080U for the BDX–XL2 test from Biodesix®, Inc., which analyzes blood plasma for two specified proteins and combines those results with five clinical risk factors in an algorithm to estimate the likelihood that a lung nodule is benign or malignant.

Service Type: Laboratory — proprietary molecular/biomarker test using blood plasma

Typical Site of Service: Clinical laboratory or reference lab; specimen collected in an ambulatory clinic or hospital outpatient setting

Clinical & Coding Specifications

Clinical Context

A 67-year-old current or former smoker presents to a pulmonology clinic after a routine chest CT performed for screening or evaluation of respiratory symptoms identifies a solitary pulmonary nodule measuring 8–30 mm. The chest CT report documents nodule size, location, margins, and any prior imaging comparison. The clinician considers noninvasive risk stratification to avoid unnecessary invasive diagnostic procedures. The clinician orders the proprietary BDX–XL2 blood-based test (Proprietary Laboratory Analyses code 0080U) from Biodesix, Inc. to measure two plasma proteins and combine those biomarker results with five clinical risk factors via the test algorithm to estimate the probability that the nodule is benign versus malignant.

Typical workflow:

The clinician documents the indication (suspicious pulmonary nodule) and relevant risk factors (age, smoking history, nodule size, nodule location, and presence/absence of previous cancer history) in the chart.
A phlebotomy encounter is scheduled at an outpatient lab or hospital outpatient drawing station (Typical Site of Service: outpatient laboratory or hospital outpatient phlebotomy). A general internal medicine, pulmonology, thoracic surgery, or oncology provider orders the test.
Blood is drawn, processed per Biodesix specimen requirements, and shipped to the performing laboratory for analysis. The laboratory runs the proprietary assay and returns a report with the combined algorithmic risk score and interpretive guidance to the ordering provider.
The ordering provider reviews results and integrates the risk estimate with imaging findings and clinical judgment to decide surveillance with serial CT, PET/CT, or pursue biopsy or resection. Documentation should link the test order to the pulmonary nodule diagnosis and record the result in the medical record.

Coding Specifications

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Modifier	Description	When to Use
`00`	Reserved/Not otherwise specified standard default	Not typically appended by providers; included in payer systems as default.
`11`	Primary procedure performed	Rare for PLA codes; may be used when this test is the primary billed service on the claim.
`22`	Increased procedural services	Use when documentation supports substantially greater laboratory work beyond usual test complexity (rare for standard PLA reporting).
`26`	Professional component	Use when billing only the professional interpretation component separate from technical lab processing (if payer allows split billing for this PLA).
`52`	Reduced services	Use if specimen is inadequate and a limited analysis is performed resulting in reduced service billed.
`53`	Discontinued procedure	Use if testing was started but discontinued for documented clinical reasons prior to completion.
`62`	Two surgeons	Uncommon for this lab test; not typically applicable.
`80`	Assistant surgeon	Not applicable to laboratory testing; included on list but rarely used.
`82`	Assistant not available	Not applicable to this lab service.
`AD`	Medical supervision by physician: more than four hours	Use for critical care oversight unrelated to standard lab processing when intensive physician supervision is documented.
`TC`	Technical component	Use when billing only the technical component (laboratory processing) and the performing laboratory bills separately from the ordering clinician.
`QK`	Medical direction of two or three technicians	Use when a physician directs multiple lab technicians for testing procedures requiring such supervision (rare for automated PLA assays).
`QX`	CRNA service with medical direction	Not applicable to this lab test.
`QY`	Medical direction of one technician	Use when a physician supervises a single technician performing a complex lab procedure requiring direct medical direction.

Taxonomy Code	Specialty	Notes
`207RJ0000X`	Pulmonary Disease	Common ordering specialty for evaluation of pulmonary nodules.
`207L00000X`	Thoracic Surgery	Orders when surgical evaluation for nodule management is being considered.
`2084P0800X`	Hematology & Medical Oncology	May order when cancer risk stratification is needed.
`207M00000X`	Internal Medicine	Primary care physicians or internists ordering as part of nodule workup.
`363A00000X`	Diagnostic Laboratory	Performing laboratory taxonomy for the lab performing the PLA assay.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R91.1`	Solitary pulmonary nodule	Primary indication for ordering `0080U` to stratify probability of benign vs malignant nodule.
`R91.8`	Other nonspecific abnormal findings of lung field	Used when imaging shows indeterminate pulmonary findings prompting biomarker assessment.
`Z13.6`	Encounter for screening for malignant neoplasm of respiratory organs	May apply when ordered during screening evaluation of at-risk patients with incidental nodules.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Relevant when there is high suspicion or established diagnosis requiring adjunctive testing and management.
`Z85.118`	Personal history of other malignant neoplasm of bronchus and lung	Historical cancer increases pre-test probability and informs interpretation of the BDX–XL2 result.
`F17.210`	Nicotine dependence, cigarettes, uncomplicated	Smoking history is a clinical risk factor incorporated into the test algorithm.
`R91.8A`	Indeterminate pulmonary nodule on imaging (if local variant)	Used in systems that capture more granular indeterminate nodule coding for workup decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0080U`	BDX–XL2 test (Biodesix) — blood plasma assay combining two protein biomarkers with clinical risk factors to estimate likelihood a lung nodule is benign or malignant	Primary proprietary laboratory test being ordered for noninvasive risk stratification of indeterminate pulmonary nodules.
`71045`	Radiologic examination, chest, single view, frontal	Often performed as an initial imaging study in workup prior to CT and may be part of baseline assessment.
`71250`	Computed tomography, thorax; without contrast material	Chest CT is the primary imaging modality used to detect and characterize pulmonary nodules prior to ordering biomarker testing.
`78815`	Positron emission tomography (PET) with concurrently acquired CT for attenuation correction and anatomical localization, whole body	PET/CT is commonly used after biomarker testing if risk is elevated to further evaluate metabolic activity of a nodule.
`32405`	Biopsy, lung or mediastinum, percutaneous needle; with imaging guidance	Invasive tissue sampling that may be performed if noninvasive risk stratification suggests high likelihood of malignancy.
`88305`	Pathology examination, surgical specimen, gross and microscopic examination	Pathology code used to report evaluation of biopsy or resection specimens obtained following imaging and risk assessment.

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