Summary & Overview
CPT 0157U: APC mRNA Sequence Analysis (CustomNext® + RNA)
CPT code 0157U designates a Proprietary Laboratory Analyses (PLA) test for the CustomNext® + RNA: APC assay from Ambry Genetics®, covering mRNA sequence analysis of the APC gene in conjunction with primary full-sequence testing. As a PLA code, 0157U identifies a single manufacturer‑specific laboratory service and supports clinical reporting, claim submission, and payor-specific coverage processes for this unique molecular diagnostic.
Key national payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent, typical service setting, and payer landscape considerations. The publication summarizes available benchmarks and coding context relevant to molecular diagnostics, highlights policy and coverage themes that affect PLA tests broadly, and outlines clinical context for APC gene mRNA analysis.
This resource is intended to inform billing teams, laboratory operations, and health policy stakeholders about the role of CPT code 0157U in claims workflows and payer interactions. Data not provided in the input—such as specific payer policy determinations, fee schedules, and utilization statistics—are noted as unavailable.
Billing Code Overview
CPT code 0157U is a Proprietary Laboratory Analyses (PLA) code reported for the CustomNext® + RNA: APC test from Ambry Genetics®. The code applies to a single, manufacturer-specific laboratory test for mRNA sequence analysis of the APC gene, used in targeted genetic evaluation related to APC-driven conditions.
Service Type: Molecular diagnostic laboratory testing (proprietary/PLA)
Typical Site of Service: Clinical laboratory or reference lab facility
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with a personal or family history suggestive of hereditary colorectal cancer (such as multiple colorectal adenomas, early-onset colorectal cancer, or a known familial APC pathogenic variant) is referred for targeted mRNA sequencing of the APC gene using the CustomNext® + RNA: APC test from Ambry Genetics®. The clinical workflow begins in a genetics clinic or gastroenterology practice: the provider documents indications and obtains informed consent for genetic testing, orders the proprietary laboratory analysis using 0157U alongside the primary CPT for full APC sequencing, and collects a blood or other validated specimen. The sample is sent to the performing laboratory, which conducts mRNA sequence analysis to detect splice-altering variants and confirm variant effects on transcript structure. The laboratory reports results to the ordering provider; genetic counseling is provided to the patient to interpret positive, negative, or variant of uncertain significance findings and to discuss surveillance or family testing when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation portion of the test separated from the technical component. |