Summary & Overview
CPT 0203U: PredictSURE IBD™ Quantitative RT–PCR Prognostic Test
CPT code 0203U designates the PredictSURE IBD™ test, a proprietary quantitative RT–PCR whole-blood assay developed by PredictImmune Ltd. and KSL Diagnostics that provides prognostic information for aggressive inflammatory bowel disease phenotypes such as Crohn’s disease and ulcerative colitis. As a PLA code, 0203U describes a single manufacturer- or laboratory-specific diagnostic service and fits into the broader trend of precision diagnostics informing therapeutic choices in IBD care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of coverage posture and payer engagement for PLA molecular diagnostics, clinical context on how a prognostic IBD blood test is used in care pathways, and summaries of common billing considerations. The publication also outlines typical sites of service and service type to aid coding and revenue cycle teams.
This summary provides context for clinicians, laboratory operations, and payers considering incorporation of PLA tests into IBD management. Data not available in the input will be noted where applicable in the full publication.
Billing Code Overview
CPT code 0203U is a Proprietary Laboratory Analyses (PLA) code that describes a single, specific laboratory test: the PredictSURE IBD™ Test by PredictImmune Ltd. and KSL Diagnostics. The test is a quantitative RT–PCR assay performed on whole blood that generates a prognostic result to help guide clinical management of aggressive inflammatory bowel disease (IBD) subtypes, including Crohn’s disease and ulcerative colitis.
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Service type: Laboratory molecular diagnostic test (quantitative RT–PCR on whole blood)
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Typical site of service: Clinical laboratory or hospital laboratory; specimen collection occurs in outpatient clinics or ambulatory care settings
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with newly diagnosed moderate-to-severe Crohn’s disease presents to a gastroenterology clinic to establish a treatment plan. The clinician orders the PredictSURE IBD™ Test (0203U), a quantitative RT–PCR whole blood assay, to assess the patient’s immune signature and predict likelihood of aggressive disease course. Blood is collected during the outpatient visit, sent to the performing laboratory with appropriate patient identifiers and clinical information (diagnosis, current medications, prior biologic exposure). The laboratory performs RNA extraction and RT–PCR, quantifies the predictive gene expression signature, and reports a risk category to the ordering provider. The result is used by the gastroenterologist and multidisciplinary team when discussing initial therapy intensity (for example, step-up vs early biologic therapy) and surveillance planning. Typical site of service is an outpatient clinic or ambulatory phlebotomy center; sample transport to a centralized clinical laboratory is required. Billing uses Proprietary Laboratory Analyses code 0203U. Common clinical workflow steps: order placement in the EHR, outpatient venipuncture, specimen labeling and shipment, laboratory processing and reporting, and clinician review with documentation in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |