Summary & Overview
CPT 0287U: ThyroSeq CRC Thyroid NGS Recurrence-Risk Test
Headline: New PLA CPT code 0287U identifies ThyroSeq® CRC, an NGS-based thyroid recurrence-risk test
CPT code 0287U designates ThyroSeq® CRC, a proprietary next-generation sequencing (NGS) laboratory assay developed by CBLPath Inc. and the University of Pittsburgh Medical Center to evaluate 112 genes on thyroid specimens (FNA or FFPE) and report a risk category for cancer recurrence. As a PLA code, 0287U represents a single manufacturer's test and is used in claims to identify this specific molecular diagnostic service.
This publication covers national payer handling for 0287U, focusing on commercial and federal plans. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and the role of the assay in risk stratification; benchmark considerations for coverage and coding; typical sites of service and billing practice points; and a summary of payer-specific considerations where available.
The report is intended to inform revenue cycle, laboratory, and clinical stakeholders about coding identification and the clinical purpose of 0287U, provide benchmark context for payer coverage approaches, and summarize areas where policy updates or clarifications are commonly required. Data not available in the input will be noted as such in detailed sections.
Billing Code Overview
CPT code 0287U is a Proprietary Laboratory Analyses (PLA) code that describes a single, manufacturer-specific laboratory test: ThyroSeq® CRC developed by CBLPath Inc. and the University of Pittsburgh Medical Center. The test uses next-generation sequencing (NGS) on thyroid specimens — such as fine needle aspiration (FNA) samples or formalin–fixed paraffin–embedded (FFPE) tissue — to analyze a 112-gene panel and applies an algorithmic interpretation to report a risk for cancer recurrence as low, intermediate, or high.
Service Type: Laboratory molecular diagnostic testing using NGS for recurrence risk stratification
Typical Site of Service: Clinical laboratory or pathology service, using specimens collected in outpatient or inpatient clinical settings
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a thyroid nodule detected on ultrasound and an indeterminate cytology result from fine needle aspiration (FNA), such as Bethesda category III (AUS/FLUS) or IV (follicular neoplasm/suspicious for follicular neoplasm). The clinician orders the ThyroSeq® CRC assay (0287U) to provide molecular profiling and an algorithmic estimate of risk for cancer recurrence (low, intermediate, or high) using next-generation sequencing of 112 genes on the submitted thyroid specimen (FNA material or FFPE tissue). The specimen is collected in the ambulatory clinic or radiology suite during ultrasound-guided FNA or obtained from surgical pathology (FFPE block) after diagnostic lobectomy. The specimen is sent to the proprietary laboratory (CBLPath/University of Pittsburgh Medical Center) with appropriate accessioning and clinical history. Results guide multidisciplinary decisions about surveillance intensity, need for completion thyroidectomy, radioactive iodine consideration, or referral to endocrine surgery and oncology. Typical sites of service include outpatient clinic, outpatient radiology suite, and hospital pathology laboratory when FFPE material is submitted.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Rare; generally not used for laboratory PLA codes but available when no other modifier applies |
26 | Professional component | Use when reporting only the professional interpretation component separate from the technical laboratory processing (uncommon for PLA where global reporting is typical) |
52 | Reduced services | Use if the laboratory provides a limited version of the test or partial sequencing due to inadequate specimen |
53 | Discontinued procedure | Use if testing is discontinued prior to completion due to specimen failure or processing error |
62 | Two surgeons | Not typically applicable to lab testing; include only if multiple surgeons involved in specimen acquisition impact billing |
78 | Unplanned return to OR | Not applicable to the lab test itself; may apply to associated surgical events |
90 | Reference (outside) laboratory | Use when the performing lab is an outside reference laboratory from the ordering facility |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when a qualified non-physician practitioner orders or manages related clinical services per payer rules |
QK | Service provided in part by a CRNA with medical direction by a physician | Not typical for this lab assay; include only if anesthesia services relate to specimen acquisition |
QX | CRNA service with medical direction | See QK note; rarely relevant |
QY | Medical direction of one CRNA by physician | Rarely relevant to the assay itself |
TC | Technical component | Use when the billing separates the technical laboratory processing from the professional interpretation |
SH | Diagnostic test performed by a supervising physician | Use when the supervising physician of the lab signs out or supervises testing |
SJ | Telemedicine originating site (rural health clinic) | Use when specimen collection or ordering occurs via telemedicine workflows where payers require this modifier |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Endocrinology | Ordering and interpretation of thyroid molecular testing for nodule risk stratification |
| 207P00000X | Pathology | Surgical pathology or cytopathology involvement in specimen processing and interpretation |
| 208000000X | General Surgery | Endocrine/head and neck surgeons who obtain tissue (FNA coordination or surgical specimens) |
| 363L00000X | Clinical Laboratory | Laboratory directors and molecular pathology specialists who perform and validate the assay |
| 163W00000X | Diagnostic Radiology | Radiologists who perform ultrasound-guided FNA specimen acquisition |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E04.1 | Nontoxic single thyroid nodule | Common indication for FNA and molecular testing when cytology is indeterminate |
E04.2 | Multinodular goiter | Nodules with indeterminate cytology in multinodular glands may be sent for ThyroSeq to guide management |
E07.1 | Thyroid nodule, unspecified | General code used when a thyroid nodule prompts molecular profiling |
C73 | Malignant neoplasm of thyroid gland | Used when malignancy is confirmed or strongly suspected; assay helps stratify recurrence risk after diagnosis |
E01.1 | Iodine-deficiency related diffuse goiter | Nodules arising in goiter may require molecular testing if cytology is indeterminate |
R22.1 | Localized swelling, mass and lump of neck | Symptom code that may prompt evaluation including FNA and molecular testing |
R94.5 | Abnormal results of imaging studies of other body structures | Used when ultrasound findings trigger further molecular workup |
Z85.850 | Personal history of malignant neoplasm of thyroid | Relevant when assessing recurrence risk and planning surveillance; ThyroSeq CRC reports recurrence risk categories |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
10021 | Fine needle aspiration without imaging guidance | May be used for initial FNA specimen collection submitted for ThyroSeq testing when performed without imaging guidance |
10022 | Fine needle aspiration with imaging guidance | Used when ultrasound-guided FNA is performed to obtain the sample that is sent for molecular testing |
88305 | Level IV surgical pathology, gross and microscopic examination | Used for cytopathology or histopathology examination of thyroid surgical specimens that may prompt or accompany molecular testing on FFPE tissue |
88342 | Immunohistochemistry, per single antigen; initial single antibody stain | Ancillary testing that may be performed on thyroid tissue alongside molecular testing to characterize tumor markers |
81479 | Unlisted molecular pathology procedure | Sometimes used historically when a specific PLA code was not available; 0287U supersedes for ThyroSeq CRC |
81225 | BRAF (v-raf murine sarcoma viral oncogene homolog B1) mutation analysis | Example of targeted molecular testing that may be ordered in parallel or prior to broad NGS panels like ThyroSeq |