Summary & Overview
CPT 0129U: BRCAplus Hereditary Breast Cancer Genetic Panel
CPT code 0129U designates the BRCAplus™ Proprietary Laboratory Analyses (PLA) test from Ambry Genetics, a targeted genetic panel that uses genomic sequence analysis plus deletion/duplication testing across eight genes implicated in hereditary breast cancer. PLA codes are unique to a single manufacturer's or laboratory's proprietary assay, making 0129U a specific identifier for this commercial test. Nationally, PLA-coded genetic tests are important because they enable payers and providers to identify and track utilization of discrete, proprietary diagnostics and align coverage, billing, and medical necessity review processes.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of clinical context for the BRCAplus™ panel, information on typical service settings, and a summary of the payment and coding implications that commonly accompany PLA tests. The publication also presents benchmarks and policy-relevant notes where available, highlights billing considerations tied to PLA designation, and summarizes typical modifiers used with laboratory testing when applicable.
This executive summary is intended to inform billing managers, laboratory administrators, payers, and clinicians about the clinical role of the BRCAplus™ assay, its coding identity as CPT code 0129U, and the types of coverage and billing considerations relevant to proprietary genetic tests at a national level.
Billing Code Overview
CPT code 0129U is a Proprietary Laboratory Analyses (PLA) code for the BRCAplus™ test from Ambry Genetics. The test performs genomic sequence analysis and deletion/duplication analysis of eight genes associated with hereditary breast cancer–related disorders.
Service Type: Genetic testing / molecular diagnostic laboratory service
Typical Site of Service: Clinical laboratory or reference laboratory setting
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a personal or family history suggestive of hereditary breast and ovarian cancer syndrome (HBOC). Common triggers include: a personal diagnosis of breast cancer at age <50, triple-negative breast cancer diagnosed at age <60, bilateral breast cancer, a history of both breast and ovarian cancer in the same patient, or multiple first- or second-degree relatives with breast, ovarian, pancreatic, or prostate (high-grade) cancers. The clinical workflow begins when a licensed clinician (often a genetic counselor, medical oncologist, or breast surgeon) documents the family and personal cancer history and orders hereditary cancer testing. A blood or saliva specimen is collected in the clinic or at a phlebotomy center and sent to the performing laboratory (Ambry Genetics) with the order for the BRCAplus™ test. The laboratory performs genomic sequence analysis and deletion/duplication analysis of the eight genes included in the BRCAplus™ panel, completes analytic and interpretive work, and issues a report with results and variant classifications. Results are returned to the ordering clinician, who reviews findings with the patient in a follow-up visit or genetic counseling session to discuss implications for cancer risk assessment, screening, and management options.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation portion is reported separately from the laboratory technical component, if applicable in split billing arrangements. |