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 | Use when no specific modifier applies and the test is billed as standard. |
| 26 | Professional component | Use if a separate professional component is billed for interpretation or consultative services when allowed.
| 52 | Reduced services | Use when the test is partially performed or specimen quantity/quality limits the full analysis.
| 53 | Discontinued procedure | Use if testing is started but discontinued due to preanalytic issues (eg, hemolyzed or insufficient specimen).
| 62 | Two surgeons | Use when two physicians of different specialties are required for a procedure related to sample collection (rare for this test).
| 78 | Unplanned return to OR | Use if a patient requires return to the operating room for source control after test-directed findings.
| 80 | Assistant surgeon | Use when an assistant surgeon is documented for a surgical procedure related to obtaining a specimen.
| 82 | Assistant surgeon (when qualified resident unavailable) | Use when a non-physician resident is unavailable and an assistant is documented.
| AD | Physician performing service | Use when identifying the specific physician performing the service for payor reporting (payor-specific).
| TC | Technical component | Use when billing only the laboratory technical component separate from professional interpretation.
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Infectious Disease | ID physicians commonly order and interpret test results. |
| 207L00000X | Allergy & Immunology | Specialists evaluate immunocompromised patients with recurrent or atypical infections. |
| 207L00000X | Clinical Pathology | Laboratory medicine/pathology oversees specimen handling and result validation. |
| 207K00000X | Critical Care Medicine | Intensivists frequently use rapid diagnostics for critically ill septic patients. |
| 207R00000X | Emergency Medicine | ED physicians may order testing for undifferentiated sepsis when rapid pathogen ID is needed. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A41.9 | Sepsis, unspecified organism | Common clinical indication when culture-negative or atypical pathogens are suspected and broader pathogen detection is needed. |
| R65.21 | Severe sepsis with septic shock | Critically ill patients in shock may prompt rapid NGS testing to identify causative organisms.
| A49.9 | Bacterial infection, unspecified | Used when a bacterial infection is suspected but standard cultures are negative or inconclusive.
| B37.7 | Disseminated candidiasis | Fungal bloodstream infections are a target for plasma NGS when blood cultures are negative.
| B96.89 | Other specified bacterial agents as the cause of diseases classified elsewhere | Used when an identified organism from NGS is specified as the cause of a clinical syndrome.
| T81.4XXA | Infection following a procedure, initial encounter | Post-procedural or device-related infections that may be evaluated with broad-range NGS testing.
| D70.9 | Neutropenia, unspecified | Immunocompromised patients with neutropenia are frequent candidates for plasma NGS testing due to atypical or occult infections.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Commonly used to obtain the plasma specimen sent for the NGS test. |
| 99223 | Initial hospital care, typically 70 minutes or more | Admission history and management for a critically ill patient whose care may prompt ordering this test.
| 87070 | Culture, bacterial; blood, aerobic and anaerobic, by automated system | Conventional blood cultures performed alongside advanced NGS testing for pathogen detection.
| 87802 | Infectious agent detection by nucleic acid (DNA or RNA), multiple types or subtypes; amplified probe technique (not NGS) | Represents other molecular diagnostic methods that may be ordered in parallel or prior to NGS testing.
| G0480 | Drugs/biologicals/toxins/venoms quantification (specimen handling code example for high complexity testing) | Administrative/payor-related HCPCS codes sometimes used to reflect high-complexity laboratory services associated with specialized testing.