Summary & Overview
CPT 0219U: Sentosa SQ HIV-1 Genotyping Assay (NGS)
CPT code 0219U designates the Sentosa® SQ HIV–1 Genotyping Assay, a proprietary next‑generation sequencing (NGS) laboratory test that detects HIV‑1 mutations in reverse transcriptase, integrase, and protease regions. As a PLA code tied to a specific manufacturer, it identifies a unique diagnostic service used in HIV resistance profiling and clinical management. Nationally, proprietary NGS assays like this are important for precision antiviral therapy and public health surveillance because they provide high‑resolution mutation detection that can influence treatment selection.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of coverage and billing context for 0219U, including payer benchmarks where available, common billing considerations, and clinical context for use of NGS‑based HIV genotyping. The publication summarizes how the code is used in laboratory settings, typical sites of service, and what stakeholders should expect when encountering this manufacturer‑specific assay in claims. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0219U is a Proprietary Laboratory Analyses (PLA) code that describes the Sentosa® SQ HIV–1 Genotyping Assay by Vela Diagnostics USA Inc. This next generation sequencing (NGS)–based laboratory test analyzes patient specimens, typically plasma, to detect HIV‑1 genomic mutations in the reverse transcriptase, integrase, and protease regions. The code represents a single manufacturer‑specific genomic assay used for HIV‑1 resistance testing and variant detection.
Service Type: Laboratory — Proprietary NGS HIV‑1 Genotyping Assay
Typical Site of Service: Clinical laboratory or reference laboratory; specimen collection commonly performed in outpatient clinics or hospital outpatient settings
Clinical & Coding Specifications
Clinical Context
A 42-year-old person with known HIV-1 infection presents for evaluation of virologic failure after a change in antiretroviral therapy. The patient has a detectable plasma viral load (>200 copies/mL) and requires genotypic resistance testing to guide selection of a revised regimen. A plasma specimen is collected in the outpatient infectious disease clinic or ambulatory infusion center and sent to the clinical laboratory performing the Sentosa® SQ HIV–1 Genotyping Assay. The laboratory performs next‑generation sequencing (NGS) of the reverse transcriptase, integrase, and protease regions to detect resistance‑associated mutations. Results are reported to the ordering clinician to inform selection of integrase, protease, and reverse transcriptase inhibitors. Typical sites of service include hospital outpatient laboratories, independent clinical reference laboratories, and ambulatory infectious disease clinics that coordinate specimen collection and send-out testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special circumstance applies to the service. |
26 | Professional component | Use when billing only the professional interpretation component, if applicable and reportable. |