Summary & Overview
CPT 0152U: Plasma NGS Pathogen Detection (Karius Test)
CPT code 0152U is a Proprietary Laboratory Analyses (PLA) code for the Karius® test, a plasma-based next-generation sequencing (NGS) assay that detects and reports potentially pathogenic organisms from cell-free microbial DNA. As a PLA code, 0152U identifies a single manufacturer-specific laboratory test and is used when that unique service is performed. This code is nationally relevant because plasma NGS assays expand diagnostic options for infectious disease evaluation, particularly in complex or culture-negative cases, and raise policy questions about coverage, clinical utility, and laboratory standards.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding and clinical context, a summary of payer coverage considerations and typical sites of service, and benchmarking information where available. The publication summarizes common billing modifiers and notes where input data are not provided. It clarifies what the code represents, the intended laboratory workflow (plasma specimen, clinical laboratory or hospital outpatient lab), and the clinical scenarios in which plasma NGS pathogen detection is used. Data not available in the input are explicitly identified in the body content rather than inferred.
Billing Code Overview
CPT code 0152U is a Proprietary Laboratory Analyses (PLA) code that applies to a single, manufacturer-specific laboratory test. Report 0152U for the Karius® test from Karius, Inc., which uses next-generation sequencing (NGS) of a plasma specimen to detect and report potentially pathogenic organisms. The test analyzes cell-free microbial DNA in plasma to identify a broad range of bacteria, viruses, fungi, and eukaryotic pathogens.
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Service type: Laboratory diagnostic testing using next-generation sequencing (NGS) of plasma
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Typical site of service: Clinical laboratory or hospital outpatient laboratory performing specialized molecular diagnostics
Clinical & Coding Specifications
Clinical Context
A hospitalized adult patient presents with persistent fever, hemodynamic instability, and negative conventional blood cultures after 48–72 hours of broad-spectrum antibiotic therapy. The treating infectious disease team suspects a deep-seated, atypical, or culture-negative bloodstream infection (for example, fungal, atypical bacterial, or fastidious organisms) or wants earlier pathogen identification to tailor therapy. A plasma-based next-generation sequencing (NGS) test is ordered to detect cell-free microbial DNA using the proprietary Karius® test (0152U).
The clinical workflow: the ordering clinician (often infectious disease) places the test through the laboratory’s ordering portal or the hospital electronic medical record. A phlebotomy draw of a plasma specimen is performed in the inpatient or outpatient phlebotomy area. The specimen is sent to the performing laboratory (Karius, Inc.) with required paperwork and consent. Results are returned to the ordering clinician typically in 24–72 hours and include detected organisms and quantitative data to guide interpretation. Results inform targeted antimicrobial adjustments, further diagnostic imaging, or source control procedures as clinically indicated. Typical sites of service include inpatient hospital wards, intensive care units, emergency departments, and outpatient specialty infectious disease clinics.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; full services |