Summary & Overview
CPT 0103U: OvaNext® 25-Gene Hereditary Ovarian Cancer Panel
CPT code 0103U identifies the OvaNext® proprietary laboratory test from Ambry Genetics®, a genomic sequencing panel targeting 25 genes linked to hereditary ovarian cancer. As a PLA code, 0103U is specific to a single manufacturer's test and signals payer processes tied to manufacturer-unique offerings. Nationally, PLA codes like 0103U are important because they represent precision diagnostics that can affect care pathways for hereditary cancer risk assessment and influence coverage policies for genetic testing.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of payer coverage patterns, the clinical context for using a 25-gene hereditary ovarian cancer panel, and typical billing considerations tied to proprietary laboratory codes. The publication covers benchmarks for utilization and reimbursement where available, recent policy developments relevant to PLA codes, and operational notes for billing and claims submission tied to laboratory sequencing services.
This overview is intended for health plan policy analysts, laboratory compliance officers, and provider billing teams seeking a national perspective on how a manufacturer-specific hereditary ovarian cancer panel is represented in billing and payer policy.
Billing Code Overview
CPT code 0103U is a Proprietary Laboratory Analyses (PLA) code for the OvaNext® test from Ambry Genetics®. It designates a genomic sequence analysis panel of 25 genes associated with hereditary ovarian cancer.
Service type: Genetic/genomic laboratory testing — targeted hereditary cancer panel
Typical site of service: Proprietary clinical laboratory or reference laboratory; specimen collection typically occurs in outpatient phlebotomy or clinic settings
Clinical & Coding Specifications
Clinical Context
A 42-year-old woman with a strong family history of ovarian and breast cancer is referred to a hereditary cancer clinic for genetic risk assessment. She reports a first-degree relative diagnosed with ovarian cancer at age 48 and a second-degree relative with early-onset breast cancer. After genetic counseling, the clinician orders the OvaNext® hereditary ovarian cancer panel to evaluate germline variants across 25 genes associated with hereditary ovarian cancer. A blood or saliva specimen is collected in the outpatient laboratory or clinic, labeled with the patient and test identifiers, and shipped to Ambry Genetics® per the manufacturer's specimen handling requirements. The laboratory performs genomic sequence analysis and returns a detailed report indicating pathogenic, likely pathogenic, or variants of uncertain significance. The ordering provider reviews results with the patient in follow-up counseling to discuss surveillance, risk-reduction options, and family cascade testing as appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies to the PLA service |
| 11 | Professional component | Append when reporting only the professional interpretation component if separated by the laboratory's billing practice
| | Professional component | Use when reporting only the physician's interpretation when services are split between entities