Summary & Overview
CPT 0113U: MiPS Prostate Score Molecular Diagnostic Test
CPT code 0113U designates the MiPS (Mi–Prostate Score) proprietary laboratory test from Mlabs, a molecular diagnostic assay that combines detection of TMPRSS2–ERG and PCA3 RNA with serum PSA to produce a prostate cancer risk score. As a PLA code, 0113U applies to a single manufacturer-specific test and informs payer coverage, coding consistency, and lab billing practices nationally. This code matters because proprietary molecular tests are increasingly used to refine prostate cancer risk assessment and influence downstream diagnostic and treatment decisions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what 0113U represents clinically, typical sites of service, and the payer landscape. The publication outlines coverage considerations, common modifiers used with laboratory services, and where the MiPS test fits in diagnostic workflows. It also summarizes expected benchmarking and policy topics that affect PLA-coded assays, such as payer-specific medical necessity requirements and Medicare laboratory payment considerations.
This national-level summary is intended to help coding, billing, and policy teams quickly understand the clinical purpose of 0113U, the payer set most relevant to national coverage discussions, and the types of operational and policy details that influence reimbursement and utilization.
Billing Code Overview
CPT code 0113U is a Proprietary Laboratory Analyses (PLA) code for the MiPS (Mi–Prostate Score) test from Mlabs. The MiPS test uses RNA amplification and fluorescence labeling to detect two prostate cancer–associated genes, TMPRSS2–ERG and PCA3. These molecular results are combined with serum PSA level in a proprietary algorithm to generate a risk score for prostate cancer.
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Service type: Molecular diagnostic laboratory test that provides a risk score for prostate cancer using gene expression and serum PSA
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Typical site of service: Independent or hospital-associated clinical laboratory and outpatient specimen collection sites
Clinical & Coding Specifications
Clinical Context
A 62-year-old man with a rising prostate-specific antigen (PSA) level and prior elevated prostate cancer risk factors presents for prostate cancer risk assessment. The urologist orders the MiPS (Mi–Prostate Score) test (0113U) from Mlabs to improve decision-making about the need for prostate biopsy. A clinic visit documents history, digital rectal exam, and serum PSA result. A blood sample or urine sample is collected per the test's instructions and sent to the performing laboratory. The lab performs RNA amplification and fluorescence labeling to detect TMPRSS2–ERG and PCA3 expression, combines those molecular results with the serum PSA value in the proprietary algorithm, and returns a numerical risk score for clinically significant prostate cancer. The result is reviewed by the ordering provider during follow-up to guide shared decision-making about biopsy, imaging, or active surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified service | Rarely used; indicates no modifier applies when required by payer. |