CPT 0142U ePlex BCID – Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 0142U: ePlex BCID Gram–Negative Panel for Positive Blood Cultures

CPT code 0142U designates a Proprietary Laboratory Analyses (PLA) test for the ePlex® BCID gram–negative panel by GenMark Diagnostics, a rapid molecular diagnostic assay for detecting gram–negative bacterial targets, key resistance genes, and Candida from positive blood cultures. This code matters nationally because rapid identification of bloodstream pathogens and resistance markers can influence antibiotic selection, infection control, and hospital resource use.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical use of the assay, the typical site of service (hospital or reference laboratories), and the national implications for laboratory and inpatient care pathways. The publication describes how the code is used for reporting a single-vendor, specific-test PLA and summarizes what stakeholders should know about coding clarity for proprietary assays.

The report provides benchmarks and payer coverage context where available, highlights policy considerations for PLA codes, and situates the clinical role of the ePlex BCID gram–negative panel within diagnostic workflows for bacteremia and candidemia. Data not available in the input will be noted as such in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0142UCPTProprietary Laboratory Analysesmolecular diagnosticsblood culturesepsis diagnosticsgenmark eplexantimicrobial resistanceclinical laboratory

Billing Code Overview

CPT code 0142U is a Proprietary Laboratory Analyses (PLA) code for the ePlex® BCID gram–negative panel from GenMark Diagnostics Inc. The test uses an automated amplified probe technique for rapid detection of multiple bloodstream infection targets, including 21 gram–negative bacterial targets, 6 resistance genes, 1 pan gram–negative bacterial target, and 1 pan Candida target from positive blood cultures.

Service type: Clinical laboratory molecular diagnostic test for pathogen and resistance gene detection.

Typical site of service: Hospital clinical laboratory or centralized reference laboratory processing positive blood culture specimens.

Clinical & Coding Specifications

Clinical Context

A hospitalized adult presents with signs of sepsis: fever, hypotension, tachycardia, and altered mental status. Blood cultures obtained at the bedside grow organisms on Gram stain showing gram-negative bacilli. The clinical team requests rapid pathogen identification and resistance marker detection to guide early antimicrobial therapy. The laboratory performs the ePlex® BCID gram–negative panel using an automated amplified probe technique on a positive blood culture bottle. Results reporting includes identification of targeted gram-negative bacteria, detection of key resistance genes, and pan-Candida/pan-gram-positive targets to assist in narrowing or broadening empiric therapy. Typical workflow: blood cultures drawn in the emergency department or inpatient unit → incubation and growth detected in automated blood culture system → positive bottle forwarded to microbiology lab → laboratory technologist performs the ePlex® BCID gram–negative panel (report with 0142U) → results communicated to the treating team and antimicrobial stewardship when available. Typical site of service: hospital inpatient laboratory and hospital emergency department with specimen collection at bedside. Typical patient scenario: adult with suspected bacteremia/sepsis after urinary tract infection or intra-abdominal infection, positive blood culture with gram-negative bacilli on Gram stain, requiring rapid organism and resistance gene identification to optimize antimicrobial therapy.

Coding Specifications

Modifier	Description	When to Use
`00`

CPT 0542U: Kidney Transplant Monitoring with Urine Metabolites and BK PCR

CPT-0388U-INVISIONFIRST-LUNG-LIQUID-BIOPSY-CTDNA-PROFILING

CPT 0388U: InVisionFirst–Lung Liquid Biopsy for NSCLC ctDNA Profiling

CPT-0628U-RENAL-DISEASE-GENETIC-PANEL-RENADX

CPT 0628U: RenaDx™ Comprehensive Renal Disease Genetic Panel

CPT-0245U-THYGENEXT-THYROID-ONCOGENE-PANEL-NGS

CPT 0245U: ThyGeNEXT® Thyroid Oncogene Panel, NGS Molecular Test

CPT-0457U-PFAS-9-PANEL-QUEST-DIAGNOSTICS

CPT 0457U: PFAS 9 Panel, Blood Plasma/Serum by LC–MS/MS

CPT-0095U-ESOPHAGEAL-STRING-TEST-EST-ELISA-BIOMARKER

CPT 0095U: Esophageal String Test (ELISA biomarkers)

CPT-0454U-CHROMOSOME-GENOME-MAPPING-OPTICAL-GENOME-MAPPING

CPT 0454U: Chromosome Genome Mapping by Optical Genome Mapping

CPT-0269U-AUTOSOMAL-DOMINANT-THROMBOCYTOPENIA-PANEL-NGS

CPT 0269U: Versiti Autosomal Dominant Thrombocytopenia NGS Panel

CPT-0213U-WHOLE-GENOME-COMPARATOR-ANALYSIS

CPT 0213U: Whole Genome and Mitochondrial Comparator Analysis

CPT-0197U-NAVIGATOR-LW-SEQUENCING-LW-BLOOD-GROUP-ANTIGEN-ANALYSIS

CPT 0197U: Navigator LW Sequencing for LW Blood Group Antigen Analysis

Showing 1–10 of 536

Taxonomy Code	Specialty	Notes
208000000X	Pathology	Clinical laboratory/pathology oversight, interpretation and reporting of microbiology results.
207Q00000X	Infectious Disease	Clinicians who order and act on rapid blood culture identification for antimicrobial management.
207L00000X	Hospitalist	Inpatient physicians ordering tests and managing sepsis/bacteremia patients.
333600000X	Clinical Laboratory Technologist/Technician	Laboratory professionals performing the ePlex assay and processing specimens.
363L00000X	Microbiology Technician	Specialists in bacteriology and molecular detection performing and validating the test.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A41.9`	Sepsis, unspecified organism	Common presenting diagnosis prompting rapid blood-culture-based molecular testing to identify causative gram-negative pathogens.
`A41.5`	Sepsis due to other Gram-negative organisms	Directly relevant — indicates gram-negative sepsis where the ePlex gram–negative panel assists in rapid identification.
`R65.20`	Severe sepsis without septic shock	Indicates systemic inflammatory response and organ dysfunction where rapid pathogen ID influences management.
`R65.21`	Severe sepsis with septic shock	High-acuity scenario requiring rapid detection of organisms and resistance markers to guide therapy.
`N39.0`	Urinary tract infection, site not specified	UTI can be a source of gram-negative bacteremia leading to positive blood cultures tested with this panel.
`K65.0`	Acute peritonitis	Intra-abdominal infections are common sources of gram-negative bacteremia prompting this test.
`J18.9`	Pneumonia, unspecified organism	Pneumonia can lead to bacteremia with gram-negative organisms; rapid ID supports targeted therapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87070`	Culture, blood, aerobic, with isolation and presumptive identification of aerobic organisms	Performed prior to or alongside molecular testing; provides organism isolation and susceptibility workflow.
`87076`	Culture, blood, aerobic, with isolation and presumptive identification of organisms; any source, multiple pathogens (automated)	Alternate culture code used in bacteremia workups; complements rapid PLA testing by providing isolates for full susceptibility.
`87471`	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique	Example molecular amplification CPT; included to represent molecular nucleic acid amplification methodology in lab workflows (different analyte).
`87499`	Unlisted molecular pathology procedure	Occasionally used historically when no PLA code existed; for PLA-coded test `0142U` is reported instead.
`87077`	Culture, blood, aerobic and anaerobic, with isolation and presumptive identification	Provides broader culture coverage alongside the rapid gram-negative panel when anaerobic pathogens are suspected.

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