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 |