CPT 0156U SMASH™ Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 0156U: SMASH™ Copy Number Sequence Analysis for Developmental Disorders

CPT code 0156U designates a Proprietary Laboratory Analyses (PLA) test — the SMASH™ assay from New York Genome Center, Marvel Genomics™ — which uses copy number sequence analysis to detect genetic variations associated with physical and mental developmental disorders. As a PLA code, 0156U is specific to a single commercial test and signals unique clinical utility in genetic diagnostics for developmental delay and related phenotypes. Nationally, PLA codes have implications for coverage policy, coding clarity, and lab reimbursement pathways because they identify single-vendor assays rather than broad method classes.

Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise context on the clinical purpose of the test, the laboratory service setting, and typical use cases in developmental genetics. The publication provides benchmarking information where available, summarizes payer coverage posture and trends for PLA tests, and outlines billing and coding considerations specific to single-source genomic assays. The report is intended to inform coding staff, laboratory billing teams, and policy analysts about the role of CPT code 0156U in current clinical and payer landscapes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0156UCPTPLAgenomic-testingcopy-number-analysisdevelopmental-disorderslaboratorymolecular-diagnostics

Billing Code Overview

CPT code 0156U is a Proprietary Laboratory Analyses (PLA) code that applies to a single, manufacturer-specific laboratory test. Report CPT code 0156U for the SMASH™ test from New York Genome Center, Marvel Genomics™, which uses copy number sequence analysis to detect genetic variations associated with physical and mental developmental disorders.

Service type: Clinical genomic laboratory testing using copy number sequence analysis to identify genetic variations linked to developmental disorders
Typical site of service: Clinical laboratory or reference laboratory setting

Clinical & Coding Specifications

Clinical Context

A pediatric or pediatric-adolescent patient presents to a genetics clinic or neurodevelopmental specialty clinic because of global developmental delay, intellectual disability, autism spectrum disorder, congenital anomalies, or unexplained developmental regression. The referring clinician (pediatrician, pediatric neurologist, clinical geneticist) documents a detailed history, family history, and physical exam noting dysmorphic features or neurologic findings. After initial metabolic, imaging, and chromosomal microarray or targeted testing are considered, the clinician orders the SMASH™ test (0156U) from New York Genome Center, Marvel Genomics™ to perform copy-number sequence analysis for detection of submicroscopic deletions, duplications, and other copy-number variants associated with physical and mental developmental disorders.

Specimen collection is typically peripheral blood drawn in an outpatient clinic, hospital outpatient phlebotomy, or inpatient pediatric unit. The sample is sent to the performing laboratory with accompanying clinical documentation and the appropriate order form. The laboratory performs next-generation sequencing–based copy number analysis, interprets detected variants against established databases and clinical guidelines, and returns a report including pathogenic, likely pathogenic, and variants of uncertain significance relevant to developmental disorders. Results are reviewed by the ordering clinician and genetic counseling is provided when actionable findings are reported. Billing uses the PLA code 0156U for the proprietary SMASH™ test.

Coding Specifications

Modifier	Description	When to Use

CPT 0136U: +RNAinsight™ for ATM Targeted mRNA Sequence Analysis

CPT-0478U-LUNG-HDPCR-NSCLC-MUTATION-PROFILING

CPT 0478U: Lung HDPCR™ NSCLC DNA/RNA Mutation Panel

CPT-0347U-RIGHTMED-PGX16-PHARMACOGENOMIC-NGS-TEST

CPT 0347U: RightMed PGx16 Pharmacogenomic NGS Test

CPT-0459U-ELECSYS-TOTAL-TAU-ABETA42-RATIO-CSF

CPT 0459U: Elecsys Total Tau/Abeta42 Ratio, CSF ECLIA

CPT-0402U-ALINITY-M-MULTIPLEX-STI-ASSAY

CPT 0402U: Abbott Alinity m Multiplex STI Assay

CPT-0259U-GFR-BY-NMR-SERUM-LABTECH-DIAGNOSTICS

CPT 0259U: GFR by NMR Serum Assay, Labtech Diagnostics

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

CPT 0628U: RenaDx™ Comprehensive Renal Disease Genetic Panel

CPT-0411U-IDGENETIX-PHARMACOGENOMIC-PSYCHOTROPIC-MEDICATION-ANALYSIS

CPT 0411U: IDgenetix® Pharmacogenomic Test for Psychotropic Medication Management

CPT-0243U-PLGF-PREECLAMPSIA-SCREEN-PERKINELMER

CPT 0243U: PlGF Preeclampsia Screen, Proprietary Risk Score

CPT-0472U-EARLY-SJOGRENS-SYNDROME-SEROLOGIC-PROFILE

CPT 0472U: Early Sjögren’s Syndrome ELISA Antibody Profile

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Taxonomy Code	Specialty	Notes
207Q00000X	Clinical Genetics	Clinical geneticists order, interpret, and communicate results for genomic copy-number testing.
207RH0000X	Pediatric Medicine	Pediatricians and pediatric neurologists frequently initiate testing for developmental delay and congenital anomalies.
2080P0208X	Pathology - Molecular Genetic Pathology	Laboratory directors and molecular pathologists oversee test validation and result interpretation.
363L00000X	Nurse Practitioner	Nurse practitioners in genetics and pediatrics coordinate testing and counseling.
367A00000X	Physician Assistant	Physician assistants in specialty clinics assist with ordering and result communication.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F84.0`	Autism spectrum disorder	ASD patients often undergo genetic testing for copy-number variants associated with neurodevelopmental phenotypes.
`F79`	Intellectual developmental disorder, unspecified	Unexplained intellectual disability prompts copy-number analysis to identify etiologic CNVs.
`R62.0`	Delayed milestone in childhood	Developmental milestone delays lead to genomic evaluation including CNV testing.
`Q87.8`	Other specified congenital malformation syndromes affecting multiple systems	Syndromic presentations with congenital anomalies warrant copy-number sequence analysis.
`G40.909`	Epilepsy, unspecified, not intractable, without status epilepticus	Seizure disorders in children can be associated with CNVs; testing may clarify genetic etiology.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81479`	Unlisted molecular pathology procedure	Used when a specific molecular test lacks a covered code; occasionally referenced before PLA codes were established.
`81229`	Chromosome microarray analysis (CMA), copy number variant detection by microarray	Alternative or complementary test for genome-wide copy-number variant detection; may be ordered prior to or alongside the SMASH™ test.
`81415`	Exome sequencing, interpretation and report (when performed)	Broader sequencing analysis that may be performed if copy-number sequencing is nondiagnostic or if single-nucleotide variant analysis is needed in addition to CNV detection.
`96372`	Therapeutic, prophylactic, or diagnostic injection	May be billed separately if intravenous contrast or sedation medications are administered during an associated imaging procedure; not billed for the lab test itself.
`36415`	Collection of venous blood by venipuncture	Billed for specimen collection in outpatient or inpatient settings when separately reportable.

`TC`	Technical component	Use when billing only the laboratory or technical portion of the test (facility or performing laboratory).
`26`	Professional component	Use when billing only the professional component (interpretation and report) if separated between entities.
`59`	Data not provided in the input.	Data not available in the input.
`52`	Reduced services	Use when the test is partially performed or a limited analysis is completed compared with the full test.
`53`	Discontinued procedure	Use when specimen was collected but testing discontinued prior to completion for patient or technical reasons.
`AD`	Physician assistant as billing provider	Use when a physician assistant billable service is relevant to specimen collection or ordering in states where applicable.
`QK`	Ordered but not performed by the billing laboratory	Use when the performing laboratory subcontracted the test and another lab performed the analysis.
`QX`	Ordering clinician performed part of the service	Use when the ordering practitioner performed the professional component in a split-billing arrangement.
`FY`	Out-of-area laboratory test	Use when the test is performed by a lab outside normal payer network or jurisdiction (payer-specific use).
`CO`	Routine care covered by workers' compensation	Use when the test is related to a workers' compensation claim and payer-specific reporting is required.
`SH`	Physician assistant -- supervising physician not present	Use where applicable to indicate scope of supervision for the billing practitioner.
`SJ`	Unusual services or supplies	Use to indicate unexpected supplies or services required to complete the test.
`TG`	Technical component performed at an alternate site	Use when the technical processing occurs at a different facility location than usual.
`QY`	Ordering physician performed noninterpretive services	Use when ordering physician provided specimen handling or noninterpretive activities tied to the test.

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