CPT 0268U aHUS Genetic Evaluation Reimbursement

CPT code 0268U designates the Versiti™ aHUS Genetic Evaluation, a proprietary next-generation sequencing (NGS) panel targeting 15 genes associated with atypical hemolytic uremic syndrome (aHUS). As a PLA code, 0268U maps to a single laboratory’s assay and is used when clinicians order this specific Versiti™ test on specimens such as blood, buccal swab, or amniotic fluid. Genetic confirmation or characterization of aHUS can influence diagnostic clarity, treatment planning, and familial risk assessment, making this code clinically significant for nephrology, hematology, and maternal-fetal medicine.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage and payment considerations across major national payers, typical sites of service and specimen types, and clinical context for when the test is used. The publication summarizes common modifier usage and service-line alignment where available and identifies gaps where payer-specific policy language or pricing benchmarks are not provided.

This report is intended for health plan policy analysts, laboratory billing staff, and clinical administrators seeking a national-level briefing on CPT code 0268U, its clinical role, and the payer landscape that governs reimbursement for this proprietary genetic assay.

Billing Code Overview

CPT code 0268U is a Proprietary Laboratory Analyses (PLA) code for the Versiti™ aHUS Genetic Evaluation performed by Versiti™ Diagnostic Laboratories. The test uses next-generation sequencing (NGS) analysis of 15 genes relevant to atypical hemolytic uremic syndrome (aHUS) and is reported for specimens such as blood, buccal swab, or amniotic fluid. The PLA designation means this code applies to a single, manufacturer- or laboratory-specific assay.

Service type: Clinical diagnostic genetic testing using NGS for aHUS-related genes
Typical site of service: Clinical laboratory or diagnostic testing facility (specimen collection may occur in outpatient clinics, hospital draw stations, or prenatal settings)

Clinical Context

A 28-year-old patient presents with recurrent episodes of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury consistent with a suspected atypical hemolytic uremic syndrome (aHUS). The nephrologist orders genetic testing to identify pathogenic variants in complement pathway genes that may influence diagnosis, prognosis, family risk counseling, and targeted therapy selection (for example, complement inhibitors). A blood draw is obtained during an outpatient visit; buccal swab or amniotic fluid may be used when blood is not available or for prenatal/family studies. The specimen is sent to Versiti™ Diagnostic Laboratories for the proprietary Versiti™ aHUS Genetic Evaluation. The laboratory performs next-generation sequencing (NGS) of 15 aHUS-relevant genes and returns a report describing pathogenic, likely pathogenic, and variants of uncertain significance, with recommendations for genetic counseling and familial testing as appropriate. Results are reviewed by the ordering clinician to guide therapy decisions (such as initiation or continuation of complement inhibition), clarify etiology, and inform cascade testing of relatives. Typical site of service is an outpatient clinic, hospital outpatient laboratory, or reference laboratory; specimen collection may occur in clinic, inpatient ward, or ambulatory phlebotomy site.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use when no special circumstance modifier applies to the laboratory test billing.

Taxonomy Code	Specialty	Notes
2080P0206X	Medical Genetics	Clinical geneticists who interpret complex germline NGS results.
207L00000X	Cardiovascular Disease (Nephrology not in standard list)	Nephrologists commonly order aHUS genetic testing as part of kidney disease workup.
207RP0012X	Nephrology	Nephrologists frequently manage aHUS and order complement gene testing.
207K00000X	Pathology	Molecular pathology laboratories and pathologists oversee NGS testing and reporting.
363L00000X	Laboratory (Allied Health)	Clinical laboratory specialists and molecular diagnosticians performing the technical testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D59.3`	Hemolytic-uremic syndrome	Directly relevant diagnosis indicating HUS; genetic testing for aHUS helps identify complement-mediated forms.
`N17.9`	Acute kidney failure, unspecified	Acute kidney injury is a common presenting feature of aHUS prompting genetic evaluation.
`D59.0`	Drug-induced hemolytic anemia	Differential diagnosis to consider when evaluating hemolysis; genetic testing helps distinguish aHUS from other causes.
`D69.5`	Secondary thrombocytopenia	Thrombocytopenia accompanies aHUS; listed as a related clinical finding driving testing.
`Z15.09`	Genetic susceptibility to other disease (family history of genetic disease)	Used for family risk assessment or cascade testing when variants are identified.
`Z31.5`	Genetic counseling and testing (encounter for)	Used when the encounter is specifically for genetic testing/counseling related to aHUS.
`O35.0XX0`	Maternal care for suspected fetal abnormality affecting management of mother, unspecified trimester	May be used when amniotic fluid genetic testing is performed prenatally for familial pathogenic variants associated with aHUS.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0268U`	Versiti™ aHUS Genetic Evaluation — NGS analysis of 15 genes relevant to aHUS (Proprietary Laboratory Analyses)	Primary code for the proprietary laboratory test performed by Versiti™ Diagnostic Laboratories on blood, buccal swab, or amniotic fluid to assess genetic causes of aHUS.
`81211`	BRCA1 gene analysis; full gene sequence analysis	Example of a hereditary disease full-gene NGS sequencing CPT used as a workflow analog for laboratory and billing processes when pedigree-based testing is performed.
`81217`	HFE (hemochromatosis) gene analysis; common variants panel	Represents targeted genetic testing panels often performed alongside genetic counseling and family risk assessment workflows.
`81479`	Unlisted molecular pathology procedure	Used when a specific proprietary test lacks an applicable analyte-specific CPT and payer requires an unlisted code for additional billing scenarios.
`36415`	Collection of venous blood by venipuncture	Specimen collection code commonly performed before sending sample to the reference lab for `0268U` testing.

Note: Only 0268U is the PLA code for the Versiti™ aHUS Genetic Evaluation. Other listed CPT codes are commonly associated procedures (specimen collection, alternative genetic tests, or unlisted molecular reporting) that may appear in the clinical workflow.

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Summary & Overview

CPT 0268U: Versiti aHUS Genetic Evaluation, 15-Gene NGS Panel