Summary & Overview
CPT 0119U: MI–HEART Ceramides, Plasma Risk Score
CPT code 0119U designates a proprietary laboratory assay — the MI–HEART Ceramides, Plasma test developed by Mayo Clinic Laboratories — that measures plasma ceramide concentrations by LC–MS/MS and reports both quantitative values and a composite risk score for major cardiovascular events such as myocardial infarction, acute coronary syndrome, and death. As a PLA code, 0119U applies to a single manufacturer- or lab-specific test and carries implications for clinical adoption, payer coverage decisions, and laboratory billing practices nationwide.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, typical sites of service and service type, common billing modifiers used with laboratory services, and the clinical context linking ceramide measures to cardiovascular risk stratification. The publication also summarizes benchmarks and policy considerations relevant to PLA-coded laboratory tests, including coding implications for proprietary assays and how PLA designation affects claim processing and prior authorization workflows.
This resource is intended for revenue cycle managers, laboratory directors, clinicians ordering advanced cardiovascular risk testing, and policy analysts seeking a concise national view of the clinical purpose and billing landscape for CPT code 0119U.
Billing Code Overview
CPT code 0119U is a Proprietary Laboratory Analyses (PLA) code for the MI–HEART Ceramides, Plasma test, a Mayo Clinic Laboratory–developed assay. The test uses liquid chromatography–tandem mass spectrometry (LC–MS/MS) to quantify plasma ceramide species and reports both numeric concentration results and a composite risk score for serious cardiovascular events, including myocardial infarction (MI), acute coronary syndrome, and death.
Service Type: Laboratory diagnostic test (proprietary PLA)
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with established coronary artery disease and recent hospitalization for unstable angina is seen in cardiology clinic for risk stratification. The clinician orders the MI–HEART Ceramides, Plasma test (0119U) performed by Mayo Clinic Laboratory to quantify plasma ceramide species using LC–MS/MS and to generate a composite risk score for future myocardial infarction, acute coronary syndrome, or cardiovascular death. Venous blood is drawn in outpatient phlebotomy or during an inpatient stay, samples are processed and shipped to the performing laboratory, and results are returned to the ordering cardiologist for incorporation into the longitudinal risk assessment and management plan. Typical sites of service include outpatient hospital laboratories, freestanding outpatient phlebotomy centers, and inpatient hospital laboratories. The service type is a Proprietary Laboratory Analysis (PLA) — a single‑source, laboratory‑developed test specific to the Mayo Clinic.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component if technical component billed separately |
90 | Reference laboratory | Use when specimen is sent to outside reference laboratory performing the test |
TC | Technical component | Use when billing only the technical component (laboratory processing/analysis) |
90 | Reference laboratory | Use when the performing laboratory is different from the billing provider (alternate to 90 where applicable) |
QK | CLIA waived test performed at remote site | Generally not applicable to LC‑MS/MS PLA; avoid unless explicitly authorized |
QX | Modifier for assistant-at-surgery (not applicable) | Not typically used for laboratory tests |
AD | Medical supervision by a physician or non-physician practitioner | Use when physician supervises the lab testing process per local billing rules |
AS | Physician assistant, NP, or CNS services | Use when these practitioners are billing under their own NPI for services related to specimen collection or ordering |
90 | Reference lab (repeat) | See above; ensure correct single use per claim |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RC0000X | Cardiovascular Disease | Cardiology specialists order and interpret risk stratification tests |
| 207LG0400X | Interventional Cardiology | Specialists managing patients with acute coronary syndromes may order this test |
| 208D00000X | Clinical Pathology | Laboratory directors/clinical pathologists oversee test validation and reporting |
| 2080P0004X | Clinical Chemistry | Clinical chemists and laboratory medicine specialists perform LC‑MS/MS testing |
| 363L00000X | Phlebotomy | Specimen collection personnel and outpatient lab staff perform blood draws |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I21.9 | Acute myocardial infarction, unspecified | Acute MI patients may have ceramide testing for prognostic risk stratification |
I20.9 | Angina pectoris, unspecified | Patients with unstable or chronic angina may undergo ceramide-based risk assessment |
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Chronic CAD patients are candidates for cardiovascular risk stratification |
I48.91 | Unspecified atrial fibrillation | Coexisting arrhythmia may factor into global cardiovascular risk evaluation |
E78.5 | Hyperlipidemia, unspecified | Dyslipidemia commonly coexists with elevated ceramide-associated risk and influences management decisions |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Specimen collection for plasma ceramide testing in outpatient or inpatient settings |
99000 | Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory | Use when specimens are transported to a reference laboratory for 0119U testing |
81000 | Urinalysis, by dipstick or tablet reagent; automated, without microscopy | Not directly related; included historically when multi‑system risk evaluation includes routine labs (ancillary) |
0000U | Proprietary Laboratory Analysis (example PLA) | PLA series codes are related in billing approach — 0119U is the specific PLA for MI–HEART Ceramides |