Summary & Overview
CPT 0165U: VeriMAP Peanut Epitope Assay, Blood Immunoassay Profile
CPT code 0165U designates the VeriMAP™ Peanut Dx–Bead–based Epitope Assay, a Proprietary Laboratory Analyses (PLA) test that maps patient epitopes to provide a probability‑based peanut allergy profile. As a PLA code, 0165U is specific to a single manufacturer’s assay and is used to bill for the lab‑performed immunoassay plus associated bioinformatics interpretation. Nationally, PLA codes like 0165U matter because they standardize reporting for proprietary tests and affect lab billing, coverage determinations, and patient access to advanced diagnostic tools.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise presentation of what 0165U represents clinically, typical service setting, and which major payers are relevant to coverage discussions. The publication also summarizes expected benchmarks and coverage considerations for proprietary allergy diagnostics, highlights clinical context for use in allergy evaluation, and outlines common billing modifiers associated with this code.
This summary is intended for national policy, payer contracting, and laboratory billing audiences who need a focused overview of the CPT PLA code, its clinical role in peanut allergy assessment, and the payer landscape for reimbursement and coverage decisions.
Billing Code Overview
CPT code 0165U is a Proprietary Laboratory Analyses (PLA) code that applies to a single, manufacturer‑specific laboratory test. Report 0165U for the VeriMAP™ Peanut Dx–Bead–based Epitope Assay from AllerGenis. This is a blood test that maps patient epitopes (immunogenic antigens in food proteins) using a bead‑based microarray immunoassay and bioinformatics to generate a patient food‑allergy profile reported as a probability of peanut allergy.
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Service type: Laboratory test — proprietary immunoassay with bioinformatics report
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Typical site of service: Clinical laboratory or reference laboratory blood testing facility
Clinical & Coding Specifications
Clinical Context
A pediatric or adult patient with a history of suspected or confirmed peanut allergy is referred by an allergist or primary care provider for specialized laboratory evaluation. The patient has symptoms suggestive of IgE-mediated food allergy (oral itching, angioedema, urticaria, wheeze, hypotension) or equivocal skin testing and serum specific IgE results. A blood sample is collected in the outpatient clinic or hospital phlebotomy suite and sent to the performing laboratory. The laboratory performs the VeriMAP™ Peanut Dx–Bead–based Epitope Assay (0165U), a proprietary microarray immunoassay with bioinformatics analysis, to map patient-specific IgE binding to peanut epitopes and generate a probability score for peanut allergy. Results are returned to the ordering clinician and integrated into the clinical assessment for counseling, management decisions (such as oral food challenge planning, immunotherapy candidacy, or dietary guidance), and documentation in the patient’s medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default - no modifier appended | Use when no special circumstances apply and the full service is provided as described. |
22 | Increased procedural services | Use when laboratory work required substantially greater effort (e.g., extensive specimen handling or custom analysis beyond routine workflow). |
26 | Professional component | Use when reporting only the professional interpretation component separate from the technical laboratory processing. |
52 | Reduced services | Use when the test is partially performed or truncated and full analysis is not completed. |
53 | Discontinued procedure | Use if specimen collection or testing was started but discontinued for clinical reasons. |
59 | Distinct procedural service | Not in provided list — Do not use. |
62 | Two surgeons — Not typically applicable to lab testing | Use only if multiple clinicians share unusual joint responsibilities for specimen procurement (rare). |
78 | Return to operating room — Not applicable | Use only if related invasive procedure required and is reportable (unlikely). |
80 | Assistant surgeon — Not applicable | Use only if another clinician assisted in an invasive procedure associated with specimen collection. |
AD | Surgical assistant — Not applicable | Use only if an assistant was required for an associated procedure. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service | Use when an advanced practice clinician independently orders and documents the test under applicable supervision rules. |
CO | Temporary absence (services performed by a locum tenens) | Use when a locum tenens clinician ordered or interpreted the test. |
QK | Clinical psychologist service — Not applicable | Use only if an unusual behavioral health component is documented (rare). |
TC | Technical component | Use when reporting only the laboratory technical component (processing, assay, and report generation) without the professional interpretation. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Allergy & Immunology | Specialists who commonly order and interpret peanut epitope assays. |
207L00000X | Pediatric Allergy & Immunology | Pediatric specialists ordering testing for suspected food allergy in children. |
208D00000X | Pediatrics | Primary care pediatricians who refer or order testing as part of evaluation. |
261QM1300X | Clinical Laboratory | Laboratories and clinical pathologists performing the proprietary assay and reporting results. |
208000000X | Family Medicine | Family physicians involved in allergy evaluation and management. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z13.820 | Encounter for screening for other disorder | Used for screening evaluation in patients with suspected food allergy where testing is ordered. |
T78.01XA | Anaphylactic reaction due to peanut, initial encounter | Relevant when confirming peanut allergy after a clinical reaction and supporting further management. |
T78.1XXA | Other adverse food reactions, not elsewhere classified, initial encounter | Used for non-anaphylactic adverse reactions to foods when peanut allergy is in the differential. |
R21 | Rash and other nonspecific skin eruptions | Common presenting symptom prompting evaluation for food allergy including peanut. |
R06.02 | Shortness of breath | Respiratory symptoms that may accompany IgE-mediated food allergy and prompt diagnostic testing. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
86003 | Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative; multiple step method, each specimen | May be used for supplemental allergen-specific IgE testing when standard immunoassays are ordered alongside the proprietary epitope assay. |
86140 | Immunoassay for allergen-specific IgE; quantitative | Commonly performed before or after epitope mapping to measure specific IgE to peanut components (e.g., Ara h proteins) as part of the allergy panel. |
36415 | Collection of venous blood by venipuncture | The phlebotomy code used for blood specimen collection required to perform the 0165U assay. |
82784 | Alpha-gal IgE (Galactose-alpha-1,3-galactose) | Occasionally ordered in differential evaluation of food allergy presentations to assess for non-peanut carbohydrate-related allergy; may be part of broader workup. |
99000 | Handling and/or conveyance of specimen for transfer from provider to laboratory | Used when specific specimen handling or courier services are separately billable in certain contexts. |