Summary & Overview
CPT 0102U: BreastNext® 17-Gene Hereditary Breast Cancer Panel
CPT code 0102U designates a Proprietary Laboratory Analyses (PLA) test — the BreastNext® 17-gene genomic sequencing panel from Ambry Genetics® — used to evaluate hereditary breast cancer risk. Nationally, PLA codes like 0102U are important because they identify manufacturer- or lab-specific molecular diagnostics that can affect coverage decisions, price transparency, and utilization tracking for precision medicine.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for a 17-gene breast cancer hereditary risk panel, typical sites of service, and the service type. The publication summarizes what payers typically consider when reviewing PLA molecular tests, relevant coverage patterns at major national payers, and common billing practices observed for lab-administered genomic sequence panels.
This report provides benchmarks and policy context useful for clinicians, billing professionals, and laboratory managers: payer coverage considerations for lab-specific molecular diagnostics, coding implications of PLA designation, and where to find further payer-specific coverage guidance. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0102U is a Proprietary Laboratory Analyses (PLA) code assigned to the BreastNext® test from Ambry Genetics®. The code represents a genomic sequence analysis panel covering 17 genes associated with hereditary breast cancer–related disorders.
Service type: Genetic testing — genomic sequence analysis panel
Typical site of service: Clinical laboratory / outpatient specimen collection
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman with a personal or family history suggestive of hereditary breast cancer presenting to a genetics clinic or oncology practice. Common presentations include early-onset invasive breast cancer (diagnosed before age 50), bilateral breast cancer, a strong family history of breast and/or ovarian cancer, or a known pathogenic variant in a relative. The clinical workflow begins with a genetic counseling visit where personal and family history are reviewed and informed consent for testing is obtained. A clinician orders the BreastNext® test (0102U) specifying the indication. A blood or saliva specimen is collected in an outpatient clinic, ambulatory surgery center, or a hospital outpatient lab and sent to the proprietary laboratory (Ambry Genetics®). The laboratory performs targeted genomic sequencing and variant interpretation across the 17 genes included in the panel and issues a report identifying pathogenic, likely pathogenic, variants, variants of uncertain significance, and benign findings. Results are returned to the ordering clinician and reviewed with the patient in a follow-up visit or telehealth session to discuss implications for surveillance, risk-reduction strategies, and cascade testing for family members. Billing uses the PLA code 0102U with an appropriate ICD-10 code reflecting the clinical indication on the claim and may include a modifier when clinically applicable (for example, reporting the professional component or unusual circumstances).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpretation/professional component of the laboratory test separate from the technical component. |
TC | Technical component | Use when billing only the technical/laboratory processing component of the test. |
59 | Distinct procedural service | Data not available in the input. |
22 | Increased procedural services | Use when the lab or provider documents unusually high complexity or additional work beyond the typical service (rare for PLA tests but applicable to extensive addenda or consultative interpretation). |
52 | Reduced services | Use when the lab performed a reduced portion of the test or specimen was inadequate for full analysis and a partial report issued. |
53 | Discontinued procedure | Use if testing was started but discontinued for documented clinical reasons prior to completion. |
AD | Approved diagnostic test | Use where payer-specific rules require reporting of demonstration or investigational status modifiers (apply per payer guidance). |
QX | Ordering/servicing physician split (modifier for CLIA-waived labs) | Use when services are split between providers and specific payer policies require QX for the ordering clinician when applicable. |
QY | Ordering/performing provider under CLIA-exempt lab | Use when the performing lab is CLIA-exempt and payer requires QY on the claim. |
QK | Laboratory test modifier for a specific contractual arrangement | Use per contractual payer/lab billing arrangements when required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Clinical Molecular Genetics | Most common specialty ordering and interpreting genetic panels. |
| 207K00000X | Clinical Genetics | Geneticists and genetic counselors associated with test ordering and interpretation. |
| 207L00000X | Hematology-Oncology | Medical oncologists who order hereditary cancer testing as part of cancer care. |
| 207P00000X | Obstetrics & Gynecology | OB/GYNs who manage patients with hereditary breast/ovarian cancer risk. |
| 363L00000X | Laboratory Director | Molecular diagnostic laboratory directors overseeing test performance. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z15.01 | Genetic susceptibility to malignant neoplasm of breast | Directly indicates a personal/family susceptibility warranting hereditary breast cancer panel testing. |
Z80.3 | Family history of malignant neoplasm of breast | Common justification for panel testing to assess inherited risk. |
C50.919 | Malignant neoplasm of unspecified site of right female breast | Indicates a personal history of breast cancer where genetic testing may inform management. |
C50.912 | Malignant neoplasm of upper-inner quadrant of left female breast | Specific personal cancer diagnosis that may prompt germline testing. |
Z85.3 | Personal history of malignant neoplasm of breast | Used when testing is performed in a breast cancer survivor to assess hereditary risk for recurrence or secondary cancers. |
Z84.81 | Family history of carrier of genetic disease | Used when family members carry known pathogenic variants and targeted testing or panels are ordered. |
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | May support genetic testing when imaging findings and history raise concern for hereditary risk. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
0102U | BreastNext®; genomic sequence analysis panel of 17 genes associated with hereditary breast cancer–related disorders (PLA) | Primary billing code for the proprietary laboratory analysis performed by Ambry Genetics®. |
88381 | Consultation and interpretation, molecular pathology procedure (if used) | May be reported by a pathologist or molecular genetics professional who provides a separate interpretive consultation beyond the standard report. |
81479 | Unlisted molecular pathology procedure | Occasionally used by payers if PLA codes are not recognized or for additional unlisted molecular testing components not covered by the PLA. |
81025 | Urinalysis non-automated (not directly related) | Data not available in the input. |
36415 | Collection of venous blood by venipuncture | Common ancillary service for specimen collection for genomic testing; billed by facility or phlebotomy service when separate from the lab charge. |