Summary & Overview
CPT 0092U: REVEAL Lung Nodule Characterization Plasma Protein Test
CPT code 0092U designates the REVEAL Lung Nodule Characterization proprietary laboratory test from MagArray, Inc., a blood-plasma assay that measures three protein biomarkers and integrates three clinical factors into an algorithmic score (0–100) to estimate malignancy risk for indeterminate lung nodules in smokers. As a PLA code, 0092U applies to a single manufacturer’s test and is used by payers to identify and adjudicate claims specific to that proprietary assay. Nationally, PLA codes like 0092U matter because they signal increasing use of commercially developed, algorithm-driven diagnostics in oncology and influence coverage policy development, utilization management, and lab billing practices.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what 0092U represents clinically and operationally, which payers are addressed, and what to expect in terms of coverage framing and coding practice. The publication summarizes the clinical context for lung nodule evaluation, explains the PLA nature of the code, outlines common billing modifiers and service settings, and highlights where data is not available in the input. This briefing is intended to inform coding professionals, laboratory billing teams, and policy analysts about the code’s purpose, typical use cases, and the payer landscape relevant to a nationally distributed proprietary lung nodule assay.
Billing Code Overview
CPT code 0092U is a Proprietary Laboratory Analyses (PLA) code for the REVEAL Lung Nodule Characterization test from MagArray, Inc. The assay detects three protein biomarkers in blood plasma and combines those results with an algorithm that includes three clinical factors to generate a score from 0 to 100. The score predicts the likelihood that an indeterminate lung nodule in a smoker is malignant.
Service Type: Laboratory-based proprietary molecular/protein diagnostic test
Typical Site of Service: Independent clinical laboratory or reference laboratory testing facility
Clinical & Coding Specifications
Clinical Context
A 68-year-old current or former smoker with a 20+ pack-year history is found to have an indeterminate solitary pulmonary nodule (8–20 mm) on low-dose CT screening or diagnostic chest CT. Pulmonary nodule management requires risk stratification to decide between surveillance imaging, PET/CT, biopsy, or surgical referral. The clinician orders the REVEAL Lung Nodule Characterization blood test (0092U) from MagArray, Inc. as an adjunctive, noninvasive diagnostic tool. Peripheral venous blood is drawn in an outpatient phlebotomy setting (ambulatory clinic or specimen collection center). The plasma sample is shipped to the performing laboratory under the manufacturer’s requirements. The laboratory runs the proprietary protein biomarker assay, combines results with three clinical factors in the vendor algorithm, and returns a numeric risk score 0–100 indicating likelihood of malignancy. The ordering clinician reviews the report and integrates the score with imaging characteristics, patient comorbidities, and shared decision-making to determine surveillance interval, need for PET/CT, tissue biopsy (bronchoscopy or CT-guided), or thoracic surgery referral.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard service | Routine reporting when no special circumstances apply |