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    v1.0.30
    OpenPayerBilling CodesProprietary Laboratory AnalysesCPT cpt-0266u-praxis-transcriptome-ngs-transcriptome-analysis
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    CPT 0266U: Praxis Transcriptome NGS for Heritable Gene Expression

    CPT code 0266U is a Proprietary Laboratory Analyses (PLA) code that reports the Praxis Transcriptome test from Praxis Genomics LLC, a next-generation sequencing (NGS) transcriptome analysis performed on specimens such as blood, frozen tissue, or formalin–fixed paraffin–embedded (FFPE) tissue to detect presence or absence of gene expression changes associated with constitutional or other heritable disorders; service type: clinical laboratory molecular diagnostic testing using transcriptome analysis; typical site of service: clinical laboratory or reference testing facility processing blood, frozen tissue, or FFPE specimens.

    For related coverage guidance, see recent payer policy updates: Oral Cancer Screening and Testing, RTM Testing for Alpha-1 Antitrypsin Deficiency, Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policy.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A pediatric or adult patient with a suspected constitutional or heritable genetic disorder is referred for transcriptome testing after initial genetic evaluation. The patient presents with unexplained developmental delay, multiple congenital anomalies, neuromuscular signs, or a family history suggesting a hereditary syndrome. A geneticist, neurologist, or clinical molecular pathologist orders the 0266U Praxis Transcriptome test to evaluate gene expression signatures from a submitted specimen (peripheral blood, frozen tissue, or formalin–fixed paraffin–embedded tissue).

    Specimen collection occurs in an outpatient clinic, hospital inpatient unit, or surgical pathology suite depending on the tissue source. For blood, a phlebotomist draws EDTA tube(s) and ships per laboratory instructions. For FFPE or frozen tissue, the surgical team or pathology department prepares and sends the block or fresh/frozen samples with appropriate chain-of-custody and requisition. The laboratory performs RNA extraction, next-generation sequencing (NGS) transcriptome analysis, bioinformatic processing, and clinical interpretation to determine presence or absence of gene expression changes associated with constitutional or heritable disorders. Results report is routed to the ordering clinician for correlation with clinical findings and family counseling. Billing for the proprietary laboratory analysis is reported using 0266U with applicable modifiers to indicate professional/technical components, bilateral procedures, unusual circumstances, or payer-specific reporting requirements.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    83020Hemoglobin electrophoresis or related hematologic laboratory testPreanalytic hematology tests may be performed on blood specimens prior to RNA extraction in complex cases.
    88342Immunohistochemistry, per single antigen-antibody stainAncillary pathology stains on FFPE tissue that may be performed alongside to phenotype tissue before molecular testing.
    81479Unlisted molecular pathology procedureUsed when a specific molecular or genomic test is not represented by a PLA or existing CPT; sometimes used for related custom assays when applicable.
    96372Therapeutic, prophylactic, or diagnostic injectionProcedural codes for administration of agents are unrelated but may appear on the same claim for clinic visits where blood is drawn.
    99000Handling and/or conveyance of specimen to off-site labApplicable when an institution bills separately for specimen transport or special handling associated with sending samples to Praxis Genomics.

    Note: The proprietary laboratory analysis described by 0266U is billed specifically for the Praxis Transcriptome test; the codes above represent common ancillary or sequential services in the clinical workflow.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2080P0206X
    207RH0000X
    207L00000X
    2084P0800X
    208000000X
    207RE0101X
    225500000X
    103TH0100X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    D82.1Di George's syndrome
    E34.9Endocrine disorder, unspecified
    F70Mild intellectual disabilities
    F82Specific developmental disorder of motor function
    F84.0Autistic disorder
    G71.3Mitochondrial myopathy, not elsewhere classified
    I69.398Other sequelae of cerebral infarction
    P94.2Congenital hypotonia
    Q75.8Other specified congenital malformations of skull and face bones
    Q87.0Congenital malformation syndromes predominantly affecting facial appearance

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Carrier Testing Panels for Genetic Diseases (for Kentucky Only)UnitedHealthcare2026-10-01
    Genetic Testing for Neurological Disorders (for Kansas Only)UnitedHealthcare2026-10-01
    Genetic and Molecular TestingProvidence Health Plan2026-10-01
    Cell-Free Fetal DNA Testing (for Idaho Only)UnitedHealthcare2026-10-01
    Next Generation Sequencing for Minimal Residual Disease DetectionProvidence Health Plan2026-10-01
    Pharmacogenetic Panel Testing (for Kansas Only)UnitedHealthcare2026-10-01
    Non-Covered Genetic Panel TestsProvidence Health Plan2026-10-01

    Related Codes

    CPT-0001U-PRECISETYPE-HEA-MULTIPLEX-RBC-ANTIGEN-GENOTYPING

    CPT 0001U: PreciseType HEA Erythrocyte Antigen Genotyping

    CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

    CPT 0002U: PolypDX™ Urine Metabolomic Risk Assay

    CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

    CPT 0003U: Overa (MIA2G) Ovarian Cancer Risk Assay

    CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

    CPT 0005U: ExosomeDx Prostate (IntelliScore) urine gene expression test

    CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

    CPT 0007U: ToxProtect Urine Drug Screen With DNA Authentication

    CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

    CPT 0008U: H. pylori Antibiotic Resistance Gene Panel

    CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

    CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

    CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

    CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

    CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

    CPT 0011U: Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

    CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

    CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcripts

    Showing 1–10 of 536

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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