Summary & Overview
CPT 0286U: CEP72/TPMT/NUDT15 Genotyping Panel
CPT code 0286U is a Proprietary Laboratory Analyses (PLA) code for the CNT genotyping panel from RPRD Diagnostics that detects variants in CEP72, TPMT, and NUDT15 using blood or saliva. The panel provides actionable pharmacogenetic information to guide dosing of thiopurines and vincristine for patients treated for acute lymphoblastic leukemia (ALL) and inflammatory bowel disease (IBD). As a PLA code, 0286U applies to a single manufacturer’s test and is used to identify this proprietary assay in claims and utilization reporting nationwide.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national perspective on clinical context, payer coverage considerations, and coding specifics for this genotyping panel. The publication outlines the clinical purpose of the test, typical sites of service, and where this CPT code fits within genetic testing service lines. It also summarizes common modifiers associated with lab billing and highlights limitations where input data are not available.
This summary is intended to inform coding, billing, and policy stakeholders about the role of CPT code 0286U in documenting proprietary pharmacogenetic testing relevant to oncology and gastroenterology care.
Billing Code Overview
CPT code 0286U is a Proprietary Laboratory Analyses (PLA) code specific to a single laboratory test developed by RPRD Diagnostics. Report 0286U only for the CNT (CEP72, TPMT, and NUDT15) genotyping panel. The test analyzes a blood or saliva specimen to detect genetic variants in the CEP72, TPMT, and NUDT15 genes that provide therapeutic dosing information for thiopurines and vincristine used in treatment of acute lymphoblastic leukemia (ALL) or inflammatory bowel disease (IBD).
Service type: Genetic/Genomic Testing — Proprietary Genotyping Panel
Typical site of service: Clinical laboratory or outpatient specimen collection site (blood draw or saliva collection)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A pediatric patient recently diagnosed with acute lymphoblastic leukemia (ALL) is scheduled to start combination chemotherapy that includes vincristine and thiopurine agents (for example, mercaptopurine or azathioprine). An oncologist orders the 0286U CNT genotyping panel from RPRD Diagnostics using a blood or saliva specimen to identify clinically actionable variants in CEP72, TPMT, and NUDT15. Results guide dosing considerations and risk assessment for vincristine-related neurotoxicity (CEP72) and thiopurine myelosuppression or toxicity (TPMT and NUDT15).
The clinical workflow:
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Referral and order: Oncologist places an order for
0286Uas part of pre-therapy pharmacogenomic testing. -
Consent and specimen collection: Informed consent is obtained when required. A blood draw or saliva kit is collected in clinic or at an outpatient lab.
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Laboratory processing: Specimen is shipped to RPRD Diagnostics, where DNA is extracted and genotyping is performed for
CEP72,TPMT, andNUDT15variants. -
Reporting: A lab report provides genotype results, variant interpretations, and dosing implications for vincristine and thiopurines. The ordering clinician receives the report and documents the results in the medical record.
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Clinical action: The oncology team uses the report to adjust initial dosing, select monitoring frequency, and counsel the family on expected risks. Follow-up visits include documentation of any dose adjustments and adverse event monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default, no modifier | Use when no other modifier applies to the service |
22 | Increased procedural services | Use when substantially greater lab resources or complexity are documented beyond typical processing (rare for PLA but possible with additional consultative documentation)
26 | Professional component | Use when billing only the professional component if separate from the technical component
52 | Reduced services | Use when the test or analysis is partially performed or limited in scope
53 | Discontinued procedure | Use when specimen processing is initiated but the test is canceled prior to completion
62 | Two surgeons | Use when two practitioners with different specialties share responsibility for an aspect of care related to the test (rare for lab tests)
78 | Unplanned return to the operating/procedure room | Not typically used for this lab test; reserved for surgical procedures
80 | Assistant surgeon | Not typically applicable to this laboratory analysis
82 | Assistant surgeon (when qualified resident not available) | Not typically applicable to this laboratory analysis
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Not applicable for laboratory billing but included in payer modifier lists
QK | Medical direction of two, three, or four services | Use when the ordering physician medically directs multiple clinical lab services if payer requires
QX | Service performed by a CRNA or other non-physician practitioner with supervision | Rarely applicable for lab testing
QY | Medical direction of one or more assistants | Rarely applicable for laboratory tests
TC | Technical component | Use when billing only the technical component of the test (e.g., lab performs testing; ordering provider bills professional component separately)
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208000000X | Pediatric Hematology-Oncology | Most common ordering specialty for ALL pharmacogenomic testing |
207RH0000X | Medical Oncology | Orders pharmacogenomic testing for adult and adolescent patients with hematologic malignancies
2080P0208X | Pediatric Genetics | Interprets germline variants and provides counseling for inherited risk and drug response
363L00000X | Clinical Laboratory | Performs the genotyping assay and produces the 0286U PLA report
103T00000X | Pharmacy (Clinical Pharmacist) | Participates in dose interpretation and institutional pharmacogenomic guideline implementation
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C91.0 | Acute lymphoblastic leukemia | Primary indication for 0286U; genotyping informs vincristine and thiopurine dosing and toxicity risk in ALL |
K50.90 | Crohn's disease, unspecified, without complications | Thiopurines are used as immunomodulators in inflammatory bowel disease; TPMT/NUDT15 testing guides thiopurine dosing to reduce myelosuppression risk
K51.90 | Ulcerative colitis, unspecified, without complications | Similar relevance as K50.90 for thiopurine therapy and need for TPMT/NUDT15 genotyping
Z15.09 | Genetic susceptibility to other malignant neoplasm | Genetic testing context; documents presence of a pharmacogenomic risk factor influencing therapy
Z13.79 | Encounter for screening for other genetic and chromosomal anomalies | Used when ordering targeted pharmacogenetic panels as part of pre-treatment evaluation
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
80053 | Comprehensive metabolic panel | Common pre-chemotherapy baseline laboratory panel obtained before initiating therapy alongside pharmacogenomic testing |
83036 | Hemoglobin; glycosylated (A1c) | Not routine for this test specifically; included in oncology baseline panels as needed
88360 | Immunohistochemistry, per specimen; initial single antibody stain | Often part of diagnostic pathology workflow for leukemia but not directly related to genotyping
81225 | CYP2C19 (example pharmacogenetic test) | Other pharmacogenetic test sometimes ordered in parallel for medication management; demonstrates common workflow of targeted genotyping panels
99000 | Handling and/or conveyance of specimen | Ancillary code for specimen handling in some payer policies when billed separately
Note: Use of these codes varies by institution. The 0286U PLA code is specific for the CNT (CEP72, TPMT, NUDT15) genotyping panel from RPRD Diagnostics and is billed for the genotyping service; the codes above are commonly performed alongside or within the broader pre-therapy laboratory evaluation.