Summary & Overview
CPT 0130U: +RNAinsight for ColoNext, 10-Gene mRNA Panel for Hereditary Colon Cancer
CPT code 0130U designates a Proprietary Laboratory Analyses (PLA) test: the +RNAinsight™ for ColoNext® from Ambry Genetics. This targeted mRNA sequence analysis panel assesses 10 genes to help classify variants associated with hereditary colon cancer disorders. As a PLA code, 0130U identifies a single manufacturer-specific laboratory test and is reported in addition to the primary procedure code. Nationally, PLA codes like 0130U matter because they standardize reporting for proprietary genomic tests and support clinical interpretation and billing transparency for complex molecular diagnostics.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical purpose of the test, typical site of service, and how this PLA code is used in conjunction with primary procedure codes. The publication outlines payer coverage context, common billing modifiers associated with molecular laboratory services, and the clinical rationale for using mRNA-based assays to improve variant classification in hereditary colon cancer. It also provides benchmarks and policy-relevant considerations for proprietary lab tests, including coding practices, reporting expectations, and payer engagement for molecular diagnostics. Data not available in the input is noted where specific payer policies, associated taxonomies, ICD-10 diagnoses, and related codes are required.
Billing Code Overview
CPT code 0130U is a Proprietary Laboratory Analyses (PLA) code for the +RNAinsight™ for ColoNext® test from Ambry Genetics. This code applies to a targeted mRNA sequence analysis panel of 10 genes used to improve variant classification for genes implicated in hereditary colon cancer disorders. Report 0130U separately in addition to the code for the primary procedure.
Service type: Targeted mRNA sequence analysis (proprietary laboratory test)
Typical site of service: Clinical diagnostic laboratory
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with a family history of colorectal cancer and a prior identification of a variant of uncertain significance (VUS) in a colon cancer–associated gene is referred for further molecular characterization. The clinician orders the Ambry Genetics +RNAinsight™ for ColoNext® test to evaluate RNA splicing and transcript effects across a targeted 10-gene mRNA panel to improve variant classification for hereditary colorectal cancer syndromes. Specimen collection is typically a peripheral blood draw or a properly preserved blood tube shipped to the performing laboratory. The laboratory performs targeted mRNA extraction, reverse transcription, and sequence analysis to detect aberrant splicing or expression changes related to DNA variants identified by prior germline testing. Results are reported to the ordering genetics provider or genetic counselor, who integrates the RNA findings with prior DNA test results, family history, and clinical data to inform variant reclassification and management decisions. Typical sites of service include outpatient genetic counseling clinics, specialty oncology/genetics clinics, and reference laboratory facilities. The service is billed as an add-on Proprietary Laboratory Analysis using 0130U in addition to the primary DNA/genetic testing CPT code.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation component if separated from the technical laboratory processing and the payer requires split billing. |
52 | Reduced services | Use when the laboratory test was partially performed or limited relative to the full service (rare for PLA tests but applicable if a portion of the assay fails and a report is issued that documents reduced scope). |
53 | Discontinued procedure | Use when testing was started but discontinued and a report documents the reason; billing may be limited per payer rules. |
59 | Data not available in the input. | Data not available in the input. |
62 | Two surgeons or primary physicians | Use when two qualified providers share responsibility for the genetic interpretation in unusual collaborative settings (rare for lab PLA services). |
76 | Data not available in the input. | Data not available in the input. |
77 | Data not available in the input. | Data not available in the input. |
80 | Assistant surgeon | Use when an assistant participates in a related invasive procedure (not typically applicable to lab-only PLA but included if a concomitant surgical service occurs). |
82 | Assistant surgeon (when qualified resident not available) | Same context as 80 when no resident is available for a related operative procedure. |
AD | Medical supervision by a physician: more than four hours | Use if prolonged physician-directed services related to test coordination or result consultation exceed defined time thresholds per payer policy. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when such a clinician performs billable professional activities related to test interpretation if payer permits. |
QK | Medical direction of two or more simultaneous anesthesia procedures | Not applicable to PLA testing but included from provided list for completeness in mixed-service claims. |
QX | CRNA service with medical direction | Not applicable to PLA testing but included from provided list for mixed-service claims. |
TC | Technical component | Use to report only the laboratory technical processing component when the performing lab bills separately from the professional interpretation. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Clinical Molecular Genetics Laboratory | Laboratories performing specialized molecular diagnostic testing and mRNA-based variant analyses. |
| 2081S0102X | Medical Genetics & Genomics | Physicians who order and interpret genetic testing for hereditary cancer syndromes. |
| 363L00000X | Clinical Laboratory | Reference laboratories that perform high-complexity testing and report PLA codes. |
| 207K00000X | Pathology | Pathologists who may oversee molecular pathology laboratory operations. |
| 207L00000X | Genetic Counseling | Genetic counselors who coordinate testing, obtain consent, and communicate results. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z15.09 | Genetic susceptibility to other malignant neoplasms | Applicable when a patient has a known or suspected hereditary predisposition to colorectal or other cancers and further RNA analysis is ordered to clarify variant significance. |
Z80.0 | Family history of malignant neoplasm of digestive organs | Common indication when family history prompts genetic testing and reflex RNA analysis for variant interpretation. |
Z15.01 | Genetic susceptibility to malignant neoplasm of gastrointestinal tract | Relevant when testing is focused on hereditary gastrointestinal cancer syndromes. |
C18.9 | Malignant neoplasm of colon, unspecified | May be present in patients with personal history of colon cancer undergoing germline testing and RNA analysis for hereditary considerations. |
D49.0 | Neoplasm of uncertain behavior of digestive system | Used when there is uncertainty about neoplasm behavior and genetic evaluation including RNA testing may be pursued. |
Z84.81 | Family history of colon cancer | Directly relevant when family history drives genetic evaluation and the ordering of RNA-based assays to resolve VUS findings. |
Z80.9 | Family history of malignant neoplasm, unspecified | General family history code that may accompany orders for hereditary cancer genetic testing and adjunct RNA analysis. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
0130U | RNAinsight™ for ColoNext® (Ambry Genetics) — targeted mRNA sequence analysis panel of 10 genes (PLA add-on) | The primary Proprietary Laboratory Analysis code describing the specific RNA assay; reported in addition to the primary genetic test CPT when applicable. |
81211 | BRCA1 gene analysis, full sequence analysis (example of hereditary cancer DNA testing) | DNA sequence analysis codes like this represent the primary germline testing that often precedes RNA analysis; 0130U is reported in addition when RNA testing is performed to clarify DNA variants. |
81479 | Unlisted molecular pathology procedure | Used when a payer requires a general molecular pathology unlisted code as part of the testing bundle or when reporting services not otherwise specified alongside PLA reporting. |
88369 | Microdissection, manual (for molecular assays requiring tumor enrichment) | May be performed before molecular testing if tissue-based enrichment is needed prior to RNA extraction in tissue specimens, supporting downstream RNA analysis. |
80502 | CYP2C19 genotype, 2 or 3 variants (example pharmacogenomic test) | Represents other specialized molecular tests that may be performed in the same laboratory workflow; included here as commonly co-billed molecular assays. |
99000 | Handling and/or conveyance of specimen (example administrative code) | Administrative/handling codes may be appended per payer rules for specimen collection, preparation, or shipping related to specialized laboratory testing. |