Summary & Overview
CPT 0269U: Versiti Autosomal Dominant Thrombocytopenia NGS Panel
CPT code 0269U designates a Proprietary Laboratory Analyses (PLA) test: the Versiti™ Autosomal Dominant Thrombocytopenia Panel, an NGS-based 22-gene panel for autosomal dominant congenital thrombocytopenia. As a PLA code, 0269U applies to a single manufacturer-specific assay and signals a targeted, proprietary genetic diagnostic service important for accurate diagnosis and familial risk assessment of inherited platelet disorders. Nationally, PLA codes like 0269U are significant because they identify unique laboratory offerings that can influence clinical decision-making, referral patterns, and coverage reviews.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the panel, how the code is used in claims, and what types of services and sites typically submit the code. The publication presents benchmarking and coverage considerations relevant to proprietary genetic tests, describes common billing practices for NGS panels, and highlights policy updates and payer pathways that commonly affect PLA-coded assays. This material is intended for billing managers, laboratory directors, clinical geneticists, and policy analysts seeking a national summary of CPT code 0269U and its operational and policy implications.
Billing Code Overview
CPT code 0269U is a Proprietary Laboratory Analyses (PLA) code for the Versiti™ Autosomal Dominant Thrombocytopenia Panel performed by Versiti™ Diagnostic Laboratories. The test uses next–generation sequencing (NGS) of 22 genes associated with autosomal dominant congenital thrombocytopenia and is reported for a single, specific laboratory assay. The panel may aid clinicians in diagnosing symptomatic patients with suspected inherited thrombocytopenia or in evaluating familial risk for autosomal dominant platelet disorders.
Service type: Genetic diagnostic testing (next–generation sequencing panel)
Typical site of service: Clinical laboratory or specialty diagnostic laboratory
Clinical & Coding Specifications
Clinical Context
A patient presents to a hematology clinic with lifelong, mild-to-moderate thrombocytopenia and a family history of low platelet counts and easy bruising. The hematologist orders the Versiti™ Autosomal Dominant Thrombocytopenia Panel (0269U) to evaluate for pathogenic variants in 22 genes associated with autosomal dominant congenital thrombocytopenia. Specimens accepted include peripheral blood, buccal swab, or amniotic fluid when prenatal family risk assessment is indicated. The clinical workflow: the ordering clinician documents indication and obtains informed consent for genetic testing, collects the appropriate specimen at an outpatient phlebotomy or genetic counseling visit (typical site of service: hospital outpatient lab, independent diagnostic laboratory, or specialty genetic testing center), labels and ships the specimen to Versiti™ Diagnostic Laboratories, and tracks results through the laboratory electronic result system. Results guide diagnosis, family counseling, and cascade testing for at-risk relatives; testing may also be used in prenatal risk evaluation when performed on amniotic fluid with appropriate maternal-fetal medicine involvement.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / default | Use when no specific modifier applies to the service billed. |
22 | Increased procedural services | Use when documentation supports significantly greater complexity or effort for specimen handling or interpretation beyond typical laboratory workflow. |
26 | Professional component | Use if the reporting laboratory separates and bills the professional (interpretive) component distinct from technical testing. |
52 | Reduced services | Use when testing is partially performed or limited compared with the full panel (only if payer allows partial-panel billing). |
53 | Discontinued procedure | Use if specimen collection or testing was initiated but subsequently discontinued for clinical reasons. |
62 | Two surgeons / multiple providers | Rare for lab testing; use only when two qualified providers share responsibility for interpretation or testing in a way recognized by payer. |
78 | Unplanned return to the operating/procedure room | Uncommon for this test; applicable if specimen collection was part of a procedure requiring an unplanned return. |
80 | Assistant surgeon | Not typical for laboratory testing; include only if an assistant provider is separately billable for specimen collection in a facility that requires it. |
82 | Assistant not available / qualified resident | Use in limited settings where a qualified assistant is unavailable and billing rules require this modifier. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare | Use when a qualifying mid-level practitioner is the billing provider for specimen collection or ordering under Medicare rules. |
QX | CLIA waived test performed by a lab personnel under POC exceptions | Typically not applicable to this high-complexity NGS panel; include only if payer has specific procedural bundling rules. |
QY | Attending physician of record certifies inpatient hospital follow-up services | Use only if testing is performed in the context of qualifying inpatient follow-up services per payer policy. |
TC | Technical component | Use when billing only the technical component (laboratory processing/sequencing) separate from interpretation. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RP0001X | Hematology | Ordering and interpreting physicians for platelet disorder evaluation. |
| 2080P0207X | Clinical Molecular Genetics | Laboratory directors and geneticists overseeing NGS panels. |
| 208D00000X | Pathology | Molecular pathology oversight and result interpretation. |
| 208M00000X | Medical Genetics | Genetic counselors and medical geneticists involved in family risk assessment. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D69.3 | Primary thrombocytopenia | Directly relevant as a presenting diagnosis prompting genetic evaluation for congenital thrombocytopenia. |
D69.5 | Secondary thrombocytopenia, unspecified | Used when thrombocytopenia is identified but further workup including genetic testing is needed to exclude inherited causes. |
D69.6 | Thrombocytopenia, unspecified | General code applied when documentation does not specify primary vs secondary; may accompany genetic testing orders. |
Z14.8 | Genetic carrier status, other specified genetic carrier | Used when testing is performed for family risk assessment or carrier status in relatives. |
Z31.430 | Encounter for genetic counseling for known family genetic disorder carrier (male) | Used when counseling or prenatal risk assessment leads to ordering 0269U for familial risk evaluation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
81315 | BRCA1 and BRCA2 full sequence analysis (example of germline NGS) | Represents single-gene or multi-gene hereditary testing methodologies similar to NGS workflow used in 0269U; useful as a comparative billing reference for germline panels. |
81162 | CYP2C19 (genetic analysis, multiple variants) | Example of pharmacogenetic single-gene testing performed by clinical molecular labs; demonstrates laboratory processes that may be performed alongside or in the same facility as NGS panels. |
81479 | Unlisted molecular pathology procedure | Used when a specific PLA code is not available; not typically used for 0269U because 0269U is the PLA code designated for the Versiti panel. |
36415 | Collection of venous blood by venipuncture | Commonly performed at the same encounter when a blood specimen is submitted for the 0269U test. |
99213 | Office or other outpatient visit, established patient | Typical evaluation and management visit where the clinician documents indications and orders the genetic panel. |