Summary & Overview
CPT 0112U: MicroGenDX qPCR & NGS Infection Test
CPT code 0112U designates a proprietary laboratory test — the MicroGenDX® qPCR & NGS for Infection — that pairs rapid quantitative PCR screening with next‑generation sequencing of 16S and 18S rRNA genes to detect bacterial and fungal pathogens and identify antibiotic‑resistance genes. As a PLA code, 0112U applies to a single manufacturer’s test and is used when claims require a unique identifier for that product. Nationally, molecular infectious disease diagnostics are increasingly relevant for targeted antimicrobial therapy, infection control, and precision medicine, and PLA codes like 0112U help payers and providers track utilization of specific commercial assays.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical site of service, and the payer landscape. The publication also outlines what to expect from coverage benchmarking and policy documentation, highlights coding context for laboratory services, and provides clinical context on how combined qPCR and NGS testing contributes to pathogen detection and resistance profiling. Data not provided in the input (such as associated taxonomies, specific ICD‑10 diagnoses, or related codes) are noted as unavailable.
Billing Code Overview
CPT code 0112U is a Proprietary Laboratory Analyses (PLA) code for the MicroGenDX® qPCR & NGS for Infection test from MicroGenDX®. The test combines quantitative PCR (qPCR) for rapid screening and next generation sequencing (NGS) targeting 16S and 18S rRNA genes to detect and identify infectious bacteria and fungi, respectively, and to determine antibiotic resistance by detecting drug‑resistance genes.
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Service type: Laboratory diagnostic test combining molecular screening (qPCR) and sequencing (NGS) for infectious organisms and resistance markers
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Typical site of service: Clinical laboratory or reference laboratory performing molecular infectious disease testing
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an outpatient infectious disease clinic with a nonhealing diabetic foot ulcer that has failed empiric antibiotic therapy and shows signs of persistent local infection with purulence and increased erythema. Prior wound cultures have been inconclusive or grew mixed flora. The treating clinician orders the MicroGenDX® qPCR & NGS for Infection test to identify bacteria and fungi and detect resistance genes to guide targeted antimicrobial therapy. The clinical workflow begins with wound specimen collection (swab, tissue, or aspirate) in clinic or at an ambulatory wound center, proper chain-of-custody and transport to the reference laboratory, performance of rapid quantitative PCR screening followed by next-generation sequencing (16S for bacteria, 18S for fungi), laboratory interpretation including resistance gene detection, and delivery of a comprehensive report to the ordering clinician. Typical sites of service include outpatient clinics, ambulatory surgery centers for specimen collection, hospital outpatient departments, and reference laboratories performing the PLA test. The test is used when standard culture is limited or prior antibiotics may have suppressed growth, when polymicrobial or fastidious organisms are suspected, or when rapid identification and resistance profiling are needed to optimize therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service furnished without modifier | Standard reporting when no modifier applies |
11 | Normally distinct procedural service | When the test is performed as a standalone service unrelated to other procedures on the same day |
22 | Increased procedural services | When documentation supports substantially greater lab work or interpretation complexity than typical |
26 | Professional component | When reporting only the professional component (interpretation) separated from technical processing |
52 | Reduced services | When specimen processing or analysis is partially reduced and documented |
53 | Discontinued procedure | If specimen collection or test processing is started but discontinued for valid clinical reasons |
62 | Two surgeons/clinical oversight (shared responsibility) | When two providers share substantive responsibility for clinical decision-making related to testing (rare) |
78 | Unplanned return to the operating/procedure room | If test-related specimen collection occurs during an unplanned return to OR/procedure room |
80 | Assistant surgeon | If an assistant performed specimen collection in an operative setting and billing requires this modifier |
82 | Assistant not available | When an assistant required but unavailable and this affects how the service is documented |
QK | Medical direction of two or more assistants | When the ordering clinician medically directs qualified assistants involved in specimen collection |
QX | Qualified nonphysician practitioner with assistant surgeon | If a qualified nonphysician practitioner assisted in specimen collection under appropriate rules |
QY | Medical direction of one qualified nonphysician practitioner | When medical direction applies to a single assistant nonphysician during specimen collection |
TC | Technical component | When reporting only the technical component (lab processing, sequencing) separated from professional interpretation |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Infectious Disease | Ordering and interpreting complex microbiology and resistance results |
| 207L00000X | Pathology | Oversight of laboratory testing and interpretation when performed in a pathology-based lab |
| 363LF0000X | Clinical Laboratory | Laboratory directors and technologists responsible for performing PLA testing |
| 207VP0700X | Vascular Surgery | Clinicians managing diabetic foot infections who may collect tissue specimens |
| 2080P0200X | Emergency Medicine | Providers who may collect specimens in acute presentation prior to admission |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L97.421 | Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle | Chronic diabetic foot ulcers commonly require advanced molecular testing when infection persists despite therapy |
L97.422 | Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle | Bilateral or contralateral similar ulcers may be evaluated similarly with molecular identification |
E11.621 | Type 2 diabetes mellitus with foot ulcer | Diabetes with foot ulcer is a frequent clinical scenario prompting wound culture and molecular testing to identify pathogens and resistance |
M86.171 | Other osteomyelitis, right tibia and fibula | Suspected or confirmed bone infection may prompt deep tissue sampling with NGS to guide long-term therapy |
M86.172 | Other osteomyelitis, left tibia and fibula | Contralateral osteomyelitis cases follow similar diagnostic needs for pathogen ID and resistance profiling |
L08.9 | Local infection of the skin and subcutaneous tissue, unspecified | Represents localized soft-tissue infection where advanced testing can identify causative organisms when cultures are negative |
A49.9 | Bacterial infection, unspecified | Broad bacterial infection code used when organism not yet identified; molecular testing provides organism-level ID |
B37.9 | Candidiasis, unspecified | Fungal infections such as Candida may be detected by 18S rRNA sequencing when suspected in wounds |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87070 | Culture, aerobic, bacterial, with isolation and presumptive identification | Often obtained before or alongside molecular testing to allow traditional culture-based susceptibility when possible |
87077 | Culture, anaerobic, bacterial, isolation and presumptive identification | Used for deep wound or anaerobic infection evaluation complementary to molecular NGS results |
87471 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique | Example of targeted molecular testing that may be ordered when specific pathogens are suspected after broad NGS screening |
87661 | Infectious agent detection by nucleic acid (DNA or RNA); multiplex RT-PCR for multiple respiratory pathogens | Represents multiplex nucleic acid methods analogous to targeted assays ordered in parallel for site-specific testing |
88360 | Surgical pathology, gross and microscopic examination | When tissue biopsy is performed for histopathology in conjunction with molecular infectious testing |
99000 | Handling and/or conveyance of specimen for transfer from physician to lab | Administrative specimen handling codes used when clinical workflow requires special courier or handling services |