Billing Code Overview

CPT code 0290U is a Proprietary Laboratory Analyses (PLA) code that applies only to the single, specific laboratory test identified by the manufacturer. Report 0290U only for the MindX Blood Test™ – Pain performed by MindX Sciences™ Laboratory, from MindX Sciences™ Inc. The test uses a blood specimen and employs next-generation sequencing (NGS) of RNA to evaluate gene expression activity of 36 genes and applies an algorithmic analysis to report a predictive risk score for the propensity for pain.

• Service type: Laboratory molecular diagnostic test using RNA NGS with algorithmic risk scoring

• Typical site of service: Clinical laboratory or reference laboratory (blood specimen collection typically occurs in outpatient phlebotomy settings)

Clinical Context

A 52-year-old patient with chronic noncancer pain of unclear etiology presents to a pain management clinic. The patient has persistent widespread pain despite trials of first-line therapies and multiple medication adjustments. The clinician orders the MindX Blood Test™ – Pain (0290U) to assess gene expression patterns associated with pain propensity. A blood specimen is collected in the clinic or at an accredited phlebotomy site and shipped to MindX Sciences™ Laboratory. Laboratory processing uses next-generation sequencing of RNA from the blood sample to evaluate expression of 36 genes; an algorithm generates a predictive risk score for propensity for pain. Results are returned to the ordering clinician, who incorporates the score into the overall assessment and care plan, which may include further diagnostic evaluation, personalized pharmacologic selection, referral to physical medicine or behavioral health, or monitoring of treatment response.

Coding Specifications

| 26 | Professional component | Use when billing only the professional component (interpretation/analysis) of the test separately from the technical component |

| TC | Technical component | Use when billing only the technical component (laboratory processing, sequencing) separately from the professional component |

| 52 | Reduced services | Use when the test is performed but a substantial portion of the service is not completed (e.g., inadequate specimen precluding full analysis) |

| 53 | Discontinued procedure | Use if specimen collection or testing was started but discontinued for clinical reasons before completion |

| 78 | Return to operating/procedure room for related procedure during postoperative period | Rarely applicable; use only if an associated intra-procedural return occurs related to specimen collection in a surgical context |

| 80 | Assistant surgeon | Not typically used for laboratory testing; include if an assistant clinician had a billable role in a facility-based specimen collection process that qualifies under billing rules |

| QK | Medical direction of two, three, or four concurrent anesthesia procedures | Not applicable to this lab test; include only if facility billing rules require it in a bundled anesthesia/collection encounter |

| QX | CRNA service with medical direction by physician | Not applicable to the lab assay itself; use only if part of a concurrent anesthesia-related encounter that includes specimen collection services |

| QY | Medical direction of one CRNA by an anesthesiologist | Same limited applicability as other anesthesia modifiers; generally not used for 0290U |

| AS | Physician assistant, nurse practitioner, or clinical nurse specialist service as primary surgeon | Use only when an advanced practice clinician performs billable specimen collection under their own taxonomy in states where that is separately billable |

| CO | Services related to organ procurement for transplantation | Not applicable to this assay; do not use unless specimen is part of organ procurement workflow |

| CQ | Service furnished under a shared arrangement by a resident and teaching physician | Use when the interpretation involves a teaching physician and resident in a qualifying teaching setting and separate billing rules apply |

| TG | Via immediate postpartum telehealth modifier | Use only if the ordering, counseling, or result disclosure occurs via qualifying telehealth that requires this modifier under payer policy |

| 207L00000X | Physical Medicine & Rehabilitation | Clinicians in PM&R may order biomarker testing as part of multidisciplinary pain evaluation |

| 207K00000X | Neurology | Neurologists evaluate neuropathic contributors to pain and may incorporate gene-expression risk testing |

| 363A00000X | Clinical Laboratory | Laboratories perform specimen processing and sequencing; laboratory directors may bill technical components |

| 175H00000X | Nurse Practitioner | Advanced practice clinicians in pain clinics who order tests and coordinate care |

Related Diagnoses

| M54.5 | Low back pain | Common chronic pain presentation; clinician may use the test as part of an evaluation when standard therapies have failed |

| G89.4 | Chronic pain syndrome | Patients with refractory, widespread pain syndromes may be candidates for gene-expression risk assessment |

| M79.7 | Fibromyalgia | Widespread pain disorders where molecular profiling may be considered as part of a comprehensive assessment |

| R52 | Pain, unspecified | Used when the pain is a primary complaint and further stratification is needed via advanced testing |

| G90.9 | Disorder of the autonomic nervous system, unspecified | Autonomic contributors to pain may be part of complex pain phenotypes evaluated with adjunctive biomarker testing |

| M25.50 | Pain in joint, unspecified | Localized or regional joint pain that is persistent and unexplained may prompt adjunctive testing |

Related CPT Codes

| 99000 | Handling and/or conveyance of specimen to laboratory | Used in some billing contexts to report specimen handling/transport when separately billable by the sending facility |

| 81002 | Urinalysis, by dipstick or tablet reagent, nonautomated, without microscopy | Not directly related; included only when concurrent urinalysis is ordered as part of a multisystem pain evaluation |

| 99070 | Supplies and materials provided by physician over and above those usually included with the office visit | Use when additional specialized collection kits or shipping materials for 0290U are supplied and separately billable |

| G2023 | Specimen collection for molecular assay (non-covered; example HCPCS) | Molecular specimen-collection codes or HCPCS G-codes may be used by some payers to identify collection associated with advanced laboratory testing; check payer policy for applicability |