Summary & Overview
CPT 0136U: +RNAinsight™ for ATM Targeted mRNA Sequence Analysis
CPT code 0136U designates the proprietary +RNAinsight™ for ATM test from Ambry Genetics, a targeted mRNA sequence analysis used to improve classification of genetic variants in the ATM gene. As a PLA code, 0136U maps to one uniquely identified laboratory assay and is reported separately in addition to the primary procedure code when performed. Its clinical relevance lies in aiding interpretation of variants linked to ataxia telangiectasia and related hereditary conditions, which can impact diagnostic clarity and downstream clinical management.
Key national payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical sites of service, and the context in which the test is billed. The report also summarizes payer coverage considerations, common modifiers used with the service, and what information is available about associated taxonomies and diagnoses. This publication is intended to provide clinicians, laboratory billing staff, and policy analysts with a clear reference for coding and documenting this specific proprietary molecular diagnostic assay at a national level.
Billing Code Overview
CPT code 0136U is a Proprietary Laboratory Analyses (PLA) code that applies to a single, manufacturer‑specific laboratory test. Report 0136U for the +RNAinsight™ for ATM test from Ambry Genetics, a targeted mRNA sequence analysis designed to improve variant classification of the ATM (ataxia telangiectasia mutated) gene. This test supports classification of genetic variants relevant to ataxia telangiectasia and related hereditary conditions.
Service type: Targeted mRNA sequence analysis for variant classification of a single gene.
Typical site of service: Clinical laboratory or reference genetics laboratory setting performing specialized molecular diagnostics.
Clinical & Coding Specifications
Clinical Context
A patient with a personal or family history of early-onset breast cancer, pancreatic cancer, melanoma, or a known familial ATM (ataxia telangiectasia mutated) variant is referred for germline genetic testing. Prior DNA sequencing identified an ATM variant of uncertain significance (VUS) or a likely pathogenic variant requiring RNA-level analysis to clarify splicing or transcript effects. The ordering clinician (often a geneticist, genetic counselor, or oncologist) collects a blood sample or appropriate tissue specimen and sends it to Ambry Genetics for the proprietary +RNAinsight™ for ATM test. The laboratory performs targeted mRNA sequence analysis to evaluate abnormal splicing, exon usage, or transcript-level consequences, generating a report that may change variant classification and influence surveillance, risk-reduction counseling, and cascade testing for relatives. Typical workflow: clinician orders test and documents the indication in the medical record; phlebotomy or specimen collection at an outpatient clinic or hospital; specimen shipped under laboratory instructions; Ambry Genetics performs the PLA test; results communicated to ordering provider, who incorporates findings into management and genetic counseling. Typical site of service: outpatient clinic, genetic counseling center, or independent/contracted phlebotomy facility; laboratory processing occurs at the performing laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separate from the technical laboratory component, if applicable and payer allows. |
TC | Technical component | Use when billing only the technical component (laboratory processing) of the test. |
59 | Distinct procedural service | Data not available in the input. |
62 | Two surgeons | Use in surgical contexts only; generally not applicable to this lab test but included among commonly relevant modifiers for complex cases. |
78 | Unplanned return to the operating/procedure room | Not applicable to the test itself; included for completeness when post-procedure surgical interventions occur. |
82 | Assistant at surgery when regular assistant unavailable | Not applicable to the test itself; retained for payer reporting consistency when combined services occur. |
22 | Increased procedural services | Use when the complexity of test interpretation is unusually high and payer accepts modifier for laboratory professional work. |
53 | Discontinued procedure | Use if specimen collection or testing was initiated but discontinued for clinical reasons prior to completion. |
52 | Reduced services | Use if the test was partially completed and billed at reduced service level, per payer policy. |
QK | Medical direction of two, three, or four certified registered nurse anesthetists | Not relevant to the laboratory test; included where anesthesia-related services interface with surgical pathways. |
QX | CRNA service with medical direction | Not relevant to the laboratory test; listed for completeness in multi-service encounters. |
QY | Medical direction of one CRNA by an anesthesiologist | Not relevant to this outpatient laboratory service. |
AD | Medical supervision by a physician: more than four concurrent anesthesia procedures | Not applicable to this procedure. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Not applicable to the procedure billing but sometimes used in bundled encounter reporting. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Clinical Geneticist | Physicians who interpret genetic test results and place them into clinical context. |
2080P0208X | Molecular Genetic Pathology | Laboratory specialists who supervise and interpret molecular diagnostic testing. |
363L00000X | Genetic Counselor | Professionals who order and coordinate genetic testing and provide pre- and post-test counseling. |
207RC0000X | Medical Oncologist | Oncologists who order germline testing for cancer risk evaluation and treatment planning. |
207L00000X | Hematology/Oncology | Specialists who may order ATM testing when hereditary cancer syndromes are suspected. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z15.01 | Genetic susceptibility to malignant neoplasm of breast | ATM variants are associated with increased breast cancer risk; RNA testing clarifies variant pathogenicity. |
Z15.09 | Genetic susceptibility to other malignant neoplasms | Used when hereditary predisposition to cancers other than breast is evaluated, including ATM-related risks. |
D61.9 | Aplastic anemia, unspecified | ATM dysfunction can be associated with bone marrow failure syndromes in ataxia telangiectasia spectrum; RNA analysis may be relevant in selected hematologic presentations. |
G11.3 | Ataxia-telangiectasia | Direct diagnostic code for the hereditary disorder caused by biallelic ATM pathogenic variants; RNA testing supports variant interpretation. |
Z80.3 | Family history of malignant neoplasm of breast | Family history prompting genetic testing where ATM variant clarification by RNAinsight™ may be indicated. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
0136U | RNAinsight™ for ATM (targeted mRNA sequence analysis) — Proprietary Laboratory Analyses (PLA) code | Primary PLA code reported for the Ambry Genetics targeted mRNA analysis of the ATM gene; report in addition to any primary procedure code where applicable. |
81211 | BRCA1 and BRCA2 full gene sequencing and deletion/duplication analysis (example hereditary breast/ovarian cancer testing) | Often part of broader hereditary cancer panel testing; ATM RNA analysis may be ordered after DNA testing for unresolved ATM variants discovered during panels like this. |
81162 | CPT code for sequencing of an inherited cancer predisposition gene (single gene) | Representative single-gene testing code; DNA-level sequencing often precedes RNA follow-up testing such as 0136U. |
81479 | Unlisted molecular pathology procedure | Used when a specific PLA code is not available; for ATM-specific RNA analysis the PLA 0136U is the correct unique code and replaces using 81479. |
83896 | Molecular pathology procedure, interpretation and report (example) | Represents professional interpretation and reporting work that may be separately reported under applicable payer rules when professional and technical components are split. |