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 |
|---|---|---|