Summary & Overview
CPT 0245U: ThyGeNEXT® Thyroid Oncogene Panel, NGS Molecular Test
CPT code 0245U designates the ThyGeNEXT® Thyroid Oncogene Panel, a proprietary molecular diagnostic assay that uses next generation sequencing (NGS) and RNA expression analysis to evaluate indeterminate thyroid fine needle aspiration (FNA) specimens for malignancy risk. As a PLA code, 0245U maps to a single manufacturer-specific test by Interpace Diagnostics and is used to capture reporting and reimbursement for this specific thyroid oncogene panel nationally.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes coverage landscape and coding considerations for these major national payers and Medicare, highlighting how proprietary PLA codes are documented and billed across commercial and federal programs.
Readers will learn the clinical context for use of the panel, the service setting and specimen pathway, and what the code represents operationally. The report outlines expected benchmarks for code adoption, typical laboratory and site-of-service workflows, and policy considerations relevant to proprietary molecular tests. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0245U is a Proprietary Laboratory Analyses (PLA) code that describes the ThyGeNEXT® Thyroid Oncogene Panel by Interpace Diagnostics. The test uses next generation sequencing (NGS) to analyze 10 genes, detect 37 RNA fusions, and measure expression of four mRNA markers to evaluate the risk that an indeterminate thyroid fine needle aspiration (FNA) specimen is malignant.
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Service type: Molecular diagnostic laboratory test using next generation sequencing (NGS) and RNA expression analysis
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Typical site of service: Clinical laboratory processing specimens collected from outpatient or ambulatory settings, typically following a thyroid fine needle aspiration (FNA)
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman presents with a thyroid nodule found on routine neck palpation and confirmed by ultrasound. Fine needle aspiration (FNA) cytology yields an indeterminate result (e.g., Bethesda III or IV) where malignancy cannot be excluded. Her endocrinologist orders molecular testing using ThyGeNEXT® Thyroid Oncogene Panel to clarify malignancy risk and guide management between surveillance, repeat FNA, or diagnostic lobectomy. The specimen is prepared from residual FNA material and sent to a qualified reference laboratory. Turnaround includes NGS-based DNA mutation analysis, RNA fusion detection, and mRNA expression marker assessment. Results are incorporated into the patient’s chart, discussed in clinic, and used to inform surgical referral or conservative management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no specific modifier applies to the billed PLA service |
22 | Increased procedural service | Rarely applicable; use if substantially greater lab work is documented beyond standard test complexity |