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 |
11 | Primary procedure | If this test is the principal service for the encounter |
26 | Professional component | If separate reporting of professional interpretation by a physician is required |
52 | Reduced services | When specimen or testing is performed but at a reduced intensity or partial protocol |
53 | Discontinued procedure | If blood draw or processing was started but abandoned for documented medical reasons |
62 | Two surgeons | Not typical for lab testing; used if multiple providers share responsibility for the overall episode and payer requires it |
78 | Unplanned return to the operating/procedure room | Rare for this lab test; used only if related procedural complication requires return to OR |
80 | Assistant surgeon | Not applicable to lab reporting; included only when an assistant surgeon is documented for a related invasive procedure |
82 | Assistant surgeon (when qualified assistant not available) | Same contextual notes as 80 when associated surgical procedures occur |
QK | Medical direction of 2–4 technicians/technologists | Applied when the ordering/performing physician meets medical direction rules for laboratory testing staffing |
QX | Modifier identifying services performed by a certified independent laboratory contractor | When a contracted independent lab performs the test separate from the ordering entity |
QY | Attending provider in a clinical trial | When the test is performed under a qualifying clinical trial and requires this indicator |
TC | Technical component | Report if billing separates the laboratory technical component from the professional component |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208D00000X | Pulmonary Disease | Ordering clinicians who manage lung nodules and interpret risk in context |
| 207RA0000X | Radiology – Diagnostic | Radiologists who perform and report chest CT and nodule characterization supporting test use |
| 207L00000X | Pathology | Laboratory medical directors or pathologists overseeing assay validation and interpretation |
| 363L00000X | Clinical Laboratory | Laboratories and laboratory directors performing high complexity testing |
| 207X00000X | Surgery — Thoracic | Thoracic surgeons who use results to guide biopsy or resection decisions |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
R91.1 | Solitary pulmonary nodule | Primary indication for using a lung nodule characterization blood test |
R91.8 | Other nonspecific findings on diagnostic imaging of lung | Applies to indeterminate imaging findings where adjunctive testing aids risk stratification |
Z87.891 | Personal history of nicotine dependence | Smoking history influences pretest probability and is a component of the algorithm |
Z72.0 | Tobacco use, current | Active tobacco use affecting nodule risk assessment |
C34.90 | Malignant neoplasm of unspecified part of bronchus or lung, unspecified | Relevant when there is high suspicion or established diagnosis guiding further management |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
71250 | CT scan, thorax; without contrast material | Initial imaging that identifies pulmonary nodules prompting the blood test |
71260 | CT scan, thorax; with contrast material(s) | Contrast-enhanced CT used for better nodule characterization prior to additional testing |
78815 | PET/CT, whole body, for tumor imaging | Functional imaging often performed when nodule malignancy risk is intermediate or high |
32405 | Biopsy, lung or mediastinum, percutaneous needle; with imaging guidance | Tissue diagnosis obtained when noninvasive testing suggests higher malignancy probability |
32666 | Thoracoscopy, surgical; diagnostic (including biopsy) | Surgical diagnostic procedure or resection performed when indicated by combined assessment |