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
Data not available in the input.
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. |
TC | Technical component | Use when billing only the laboratory technical component (test performance) and a separate entity reports the professional interpretation. |
59 | Data not provided in input. | Data not available in the input. |
62 | Two surgeons | Applies rarely; use when two surgeons are required for a procedure portion — not typically applicable to PLA but listed as a possible modifier in the input. |
52 | Reduced services | Use when the laboratory test was partially reduced or only a subset of the full test was performed. |
53 | Discontinued procedure | Use when testing was started but subsequently cancelled and a partial service was reported. |
22 | Increased procedural services | Use when the laboratory documents work significantly greater than typical for this PLA (rare for standardized lab assays). |
80 | Assistant surgeon | Not typically applicable for laboratory-only services; included when an assisting provider is documented. |
AD | Medical supervision by the physician directing the service | Use when services are provided under direct medical supervision by the physician named with the AD modifier requirement. |
QX | Ordering physician and laboratory cross-over modifier | Use when the ordering practitioner and the performing lab have crossover billing requirements under certain payor rules (when applicable). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Medical Genetics & Genomics | Physicians with expertise in genetic disease testing and interpretation. |
| 208D00000X | Medical Oncology | Oncologists who order hereditary cancer testing as part of cancer care. |
| 362X00000X | Clinical Laboratory | Laboratories and pathologists performing specialized genetic testing. |
| 207K00000X | Obstetrics & Gynecology | OB/GYNs who manage women at increased hereditary risk for breast/ovarian cancer. |
| 2083P0207X | Hematology/Oncology Nurse Practitioner | Advanced practice clinicians who commonly order and coordinate testing. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z15.01 | Genetic susceptibility to malignant neoplasm of breast | Indicates documented genetic susceptibility testing for hereditary breast cancer and supports molecular testing like BRCAplus™. |
Z80.3 | Family history of malignant neoplasm of breast | Supports testing when relatives have breast cancer, guiding panel-based hereditary testing. |
C50.9 | Malignant neoplasm of breast, unspecified | Personal history of breast cancer often prompts hereditary testing for treatment and risk management. |
Z85.3 | Personal history of malignant neoplasm of breast | Used when a patient has a history of breast cancer and hereditary testing is considered for recurrence risk and relatives. |
Z15.09 | Genetic susceptibility to other malignant neoplasm of unspecified site | Used when genetic susceptibility testing is ordered for broader hereditary cancer risk assessment that includes breast-related genes. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
0129U | BRCAplus™ test — genomic sequence analysis and deletion/duplication analysis of 8 genes associated with hereditary breast cancer–related disorders (Proprietary Laboratory Analyses) | Primary PLA code for the Ambry Genetics BRCAplus™ test; used to report the comprehensive hereditary breast cancer panel. |
81162 | BRCA1 and BRCA2 full sequence analysis (separate, non-PLA) | Alternative or comparative coding when reporting standard BRCA1/BRCA2 sequence analysis through non-proprietary methods; may be ordered if only BRCA1/2 are being tested. |
81213 | BRCA1 deletion/duplication analysis | Used when reporting deletion/duplication analysis for BRCA1 specifically, if performed separately. |
81214 | BRCA2 deletion/duplication analysis | Used when reporting deletion/duplication analysis for BRCA2 specifically, if performed separately. |
88360 | Molecular pathology interpretation | May be used for reporting complex professional interpretation and clinical correlation when required in addition to the PLA code, depending on payer rules. |