myChoice CDx HRD (CPT 0172U) Reimbursement

CPT code 0172U is a Proprietary Laboratory Analyses (PLA) code for the myChoice® CDx test by Myriad Genetics Laboratories that assesses homologous recombination deficiency (HRD) through somatic analysis of BRCA1 and BRCA2 and a genomic instability score from tumor FFPE DNA. Nationally, PLA codes like 0172U matter because they identify manufacturer-specific molecular diagnostics that can guide targeted therapies and influence coverage and utilization patterns for oncology care. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical purpose and laboratory setting for 0172U, typical sites of service, and which major national payers are considered in coverage discussions. The publication summarizes benchmarks for claim handling and common administrative modifiers used with this test (listed separately), and provides clinical context on HRD testing for ovarian cancer treatment selection. Data not available in the input is indicated where applicable; the content focuses on national implications for laboratory diagnostics, payer engagement, and clinical utility rather than state-specific policies.

Billing Code Overview

CPT code 0172U is a Proprietary Laboratory Analyses (PLA) code for the myChoice® CDx test from Myriad Genetics Laboratories. The test determines homologous recombination deficiency (HRD) status by performing somatic mutation analysis to detect variants in tumor suppressor genes BRCA1 and BRCA2 and producing a genomic instability score used to inform ovarian cancer treatment selection.

Service type: Somatic genomic tumor testing / companion diagnostic laboratory service

Typical site of service: Clinical diagnostic laboratory using DNA extracted from formalin–fixed paraffin–embedded (FFPE) tissue of solid organ tumors.

Clinical Context

A 62-year-old woman with newly diagnosed high-grade serous ovarian carcinoma undergoes surgical tumor resection. The treating gynecologic oncologist orders tumor genomic profiling to determine homologous recombination deficiency (HRD) status to guide systemic therapy selection, including potential use of platinum-based chemotherapy and PARP inhibitor maintenance. A formalin–fixed paraffin–embedded (FFPE) block from the resected ovarian tumor is sent to the diagnostic laboratory performing the myChoice® CDx assay. The laboratory extracts tumor DNA, performs somatic sequencing and analytic algorithms to detect pathogenic variants in BRCA1 and BRCA2 and to compute a genomic instability score. Results are reported to the ordering clinician and incorporated into the oncology care plan for targeted therapy selection and eligibility assessment for maintenance treatment.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the laboratory professional/interpretive component (if applicable and payer accepts split reporting).
`TC`	Technical component	Use when reporting only the technical component (laboratory processing and analysis) if split billing occurs.

Taxonomy Code	Specialty	Notes
207L00000X	Anatomic Pathology	Pathologists direct specimen handling, quality assessment, and interpretation of tumor sequencing reports.
207P00000X	Clinical Pathology	Laboratory medical directors and clinical pathologists oversee molecular diagnostic testing and reporting.
2085R0200X	Gynecologic Oncology	Ordering clinicians who request HRD testing to guide ovarian cancer treatment.
207RC0000X	Molecular Genetic Pathology	Specialists in molecular diagnostics who validate and interpret tumor genomic assays.
208000000X	Medical Oncology	Medical oncologists use assay results to select systemic therapy and maintenance strategies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C56.9`	Malignant neoplasm of ovary, unspecified	Primary indication for HRD testing to guide ovarian cancer systemic therapy and PARP inhibitor eligibility.
`C57.3`	Malignant neoplasm of fallopian tube	HRD testing applicable for fallopian tube carcinomas with similar treatment paradigms to ovarian cancer.
`C48.1`	Malignant neoplasm of peritoneum	Peritoneal carcinomatosis related to ovarian-type tumors where HRD status informs therapy selection.
`C79.6`	Secondary malignant neoplasm of ovary and adnexa	Metastatic disease involving the ovary where tumor profiling may guide systemic therapy choices.
`Z85.3`	Personal history of malignant neoplasm of breast	Relevant when considering prior BRCA-associated cancers and correlation with tumor/genetic testing results.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88381`	Immunohistochemistry, per single antigen/alkaline phosphatase, initial single antibody stain procedure	Performed on FFPE tumor tissue when additional protein expression testing (e.g., mismatch repair proteins) is needed alongside molecular testing.
`88342`	Immunohistochemistry, multiple antibodies, per single diagnostic run	Used when multiplex IHC panels accompany molecular profiling for tumor characterization.
`88172`	Cytopathology, cell-block preparation of fluid specimens	Used if a cell block from cytology is prepared for molecular testing when no surgical specimen is available.
`81211`	BRCA1 (Breast cancer 1) gene analysis, full sequence analysis and targeted rearrangement analysis	Germline BRCA testing frequently performed in parallel or prior to tumor-based BRCA assessment for hereditary risk and therapy decisions.
`81213`	BRCA2 (Breast cancer 2) gene analysis, full sequence analysis and targeted rearrangement analysis	Complementary germline BRCA2 testing to distinguish somatic vs germline alterations and inform family risk.

OpenPayer

Summary & Overview

CPT 0172U: myChoice CDx HRD Tumor Genomic Test