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. |
TC | Technical component | Use when billing only the technical laboratory processing portion of the test. |
59 | Distinct procedural service (note: not in provided list) | Data not available in the input. |
52 | Reduced services | Use when the test is partially performed or limited relative to the full described service. |
53 | Discontinued procedure | Use when testing is started but then discontinued for patient-related or specimen-related reasons. |
22 | Unusual procedural services | Use when the laboratory documents significantly greater complexity or work than usual for the test. |
62 | Two surgeons (note: typically surgical) | Use only if two qualified providers share responsibility for interpretation under applicable payer rules. |
80 | Assistant surgeon | Use only if an assistant is reportable under payer policies for interpretation support. |
AD | Advanced beneficiary notice (note: nonstandard for labs) | Use per payer guidance when patient acceptance of financial liability is documented. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures (note: not applicable to lab) | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Medical Genetics & Genomics | Clinical geneticists and laboratory directors ordering and overseeing genetic testing. |
| 2080P0208X | Gastroenterology | Gastroenterologists referring patients with polyposis or early-onset colorectal cancer. |
| 2085R0202X | Medical Oncology | Oncologists coordinating tumor/somatic-germline correlation when hereditary cancer is suspected. |
| 363L00000X | Laboratory Director | Molecular genetic pathologists or clinical laboratory directors performing interpretation. |
| 208D00000X | Family Medicine | Primary care or family medicine clinicians initiating referral or ordering testing. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z15.09 | Genetic susceptibility to other malignant neoplasm | Indicates documented genetic susceptibility relevant when testing for APC-related hereditary cancer risk. |
Z80.0 | Family history of malignant neoplasm of digestive organs | Family history prompting APC testing for familial adenomatous polyposis or related syndromes. |
Z14.01 | Genetic carrier (carrier status) for autosomal dominant disease (not exact) | Used when documenting carrier or known variant status related to APC findings. |
C18.9 | Malignant neoplasm of colon, unspecified | Primary diagnosis in patients with colorectal cancer undergoing germline evaluation. |
D01.0 | Carcinoma in situ of colon | Early neoplastic lesions that may prompt hereditary cancer evaluation including APC testing. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
81479 | Unlisted molecular pathology procedure | Used when a specific molecular test does not have a unique CPT and may be used for other uncommon or custom analyses when billing ancillary or novel assays. |
81220 | BRCA1 and BRCA2 full gene sequence analysis (example hereditary cancer panel component) | Represents parallel germline sequencing tests commonly ordered alongside APC testing when hereditary cancer syndromes are evaluated. |
81445 | Genetic testing for colorectal cancer susceptibility (multi-gene panel) | Multi-gene panels that include APC often precede or accompany targeted mRNA assays to clarify variant significance. |
81162 | APC (APC) analysis, full gene sequence (example primary code) | The primary full sequence analysis code for APC gene testing; 0157U is reported in conjunction with the primary code for full sequence analysis to indicate the proprietary mRNA assay component. |
88360 | Immunohistochemistry, per specimen; initial single antibody stain procedure | Ancillary tumor testing sometimes performed in the workup of suspected hereditary colorectal cancers; may be part of the broader diagnostic workflow. |