Summary & Overview
CPT 0260U: Optical Genome Mapping for Chromosomal Structural Variant Detection
CPT code 0260U designates a Proprietary Laboratory Analyses (PLA) test — the Augusta Optical Genome Mapping (OGM) assay from Georgia Esoteric and Molecular (GEM) Laboratory LLC. The test performs OGM on specimens such as blood to detect chromosomal structural variants relevant to diagnosing neurodevelopmental genetic disorders. As a PLA code, 0260U is specific to this single manufacturer's test and is used to ensure accurate identification and tracking of utilization of this proprietary assay.
This publication covers key national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for OGM testing, typical sites of service, and payer coverage patterns. Content includes benchmarking of reimbursement and utilization where available, summaries of policy positions and coverage criteria, and practical coding and billing considerations tied to this PLA code.
The analysis is intended for a national audience of health plan analysts, laboratory billing staff, and policy stakeholders interested in how a single-source genomic assay is represented in claims and coverage frameworks. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0260U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to the Augusta Optical Genome Mapping test performed by Georgia Esoteric and Molecular (GEM) Laboratory LLC. The assay uses optical genome mapping (OGM) on specimens such as blood to identify chromosomal structural variants that aid in the diagnosis of neurodevelopmental genetic disorders.
Service Type: Laboratory — Molecular/Genomic Diagnostic Test
Typical Site of Service: Clinical laboratory or specialized molecular diagnostics laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A pediatric patient with global developmental delay and multiple congenital anomalies is referred by a pediatric neurologist for genomic structural variant testing after prior chromosomal microarray and targeted gene panels were non-diagnostic. A peripheral blood specimen is collected in the outpatient phlebotomy suite and sent to Georgia Esoteric and Molecular (GEM) Laboratory LLC for Augusta Optical Genome Mapping. The laboratory performs optical genome mapping (OGM) to detect chromosomal structural variants (deletions, duplications, translocations, inversions, and complex rearrangements) that can explain neurodevelopmental genetic disorders. The lab returns a structured report with detected clinically significant structural variants, technical limitations, and recommendations for confirmatory testing where applicable. Results are reviewed by the ordering pediatric neurologist or geneticist, who incorporates findings into diagnostic counseling, medical management, and family cascade testing discussions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier - standard reporting | Use when no specific modifier applies to the service. |
22 | Increased procedural services |