Summary & Overview

CPT 0298U: Praxis Somatic Transcriptome, Molecular Diagnostic

CPT code 0298U designates the Praxis Somatic Transcriptome, a proprietary laboratory assay by Praxis Genomics LLC that measures gene expression differences between paired normal and malignant patient specimens (blood, bone marrow, or FFPE/fresh tissue) to assess the functional impact of previously identified DNA mutations. As a PLA code, 0298U is unique to a single manufacturer's test and is used in billing to identify this specific molecular diagnostic service. Nationally, PLA codes matter because they standardize reporting for unique commercial tests and affect coverage and payment pathways for advanced diagnostics.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the test, expected settings for service delivery, and the payers commonly involved in coverage decisions. The publication summarizes typical billing characteristics for proprietary molecular assays, common modifiers associated with laboratory services, and the clinical context in which the test is performed. Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and service-line financial benchmarks.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0298UCPTproprietary laboratory analysismolecular diagnosticstranscriptomeoncology testinglaboratory

Billing Code Overview

CPT code 0298U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to the Praxis Somatic Transcriptome test from Praxis Genomics LLC. The assay evaluates paired normal and malignant (tumor) specimens from the patient — such as blood, bone marrow, or fresh or formalin–fixed paraffin–embedded (FFPE) tissue — to assess gene expression (activity) changes related to previously identified DNA mutations and to gauge the functional impact of those genetic changes in the malignant specimen.

Service type: Molecular diagnostic / proprietary transcriptome analysis

Typical site of service: Clinical diagnostic laboratory

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a history of metastatic colorectal adenocarcinoma undergoes surgical resection of a liver metastasis. Prior tumor DNA sequencing identified several somatic variants of uncertain functional impact. The treating oncologist orders the Praxis Somatic Transcriptome test to evaluate paired normal and malignant specimens (archived FFPE tumor tissue and a peripheral blood sample) to measure gene expression changes associated with the previously identified DNA mutations. The laboratory receives the specimens, performs RNA extraction and expression profiling, compares tumor versus matched normal expression, and generates a report describing functional consequences of the DNA alterations to assist oncologists and molecular tumor boards in therapy selection and clinical trial matching.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component provided by a physician or pathologist separate from the technical lab processing.
`TC`	Technical component	Use when billing only the technical component for laboratory processing and analysis when a separate professional interpretation is not billed.
`52`	Reduced services	Use when the laboratory test is partially reduced or not performed in full, documented and medically justified.
`53`	Discontinued procedure	Use when specimen processing is started but discontinued due to unforeseen complications that prevent completion.
`62`	Two surgeons	Use when two surgeons with distinct specialties both perform necessary operative work to obtain paired tissue specimens for testing.
`78`	Unplanned return to the operating room	Use when an unplanned reoperation is required to obtain an adequate specimen for testing.
`80`	Assistant surgeon	Use when a qualified assistant surgeon participates in specimen procurement.
`22`	Increased procedural services	Use when the laboratory or pathology service provides substantially greater work than typical reportable for this test, with documentation.
`23`	Unusual anesthesia	Use when the specimen procurement required anesthesia beyond that typically used, documented in the operative/anesthesia note.
`55`	Postoperative management only	Use when only postoperative care related to specimen procurement is being reported by the surgeon separate from the test.

Taxonomy Code	Specialty	Notes
207P00000X	Pathology	Pathologists interpret molecular test results and provide clinical correlation.
207L00000X	Clinical Laboratory	Laboratory directors and clinical laboratory specialists oversee test performance and quality.
208000000X	Medical Oncology	Oncologists order the test for treatment selection and trial eligibility.
207K00000X	Anatomic Pathology	Surgical pathologists handle tissue accessioning and specimen selection for molecular testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Metastatic liver lesion commonly biopsied/resected with tumor tissue used for paired transcriptome analysis.
`C18.9`	Malignant neoplasm of colon, unspecified	Primary colorectal cancers frequently undergo DNA and RNA testing for targeted therapy selection.
`C50.919`	Malignant neoplasm of unspecified site of right female breast	Primary breast cancers often require molecular profiling including transcriptome-level assessment for functional impact of mutations.
`C61`	Malignant neoplasm of prostate gland	Prostate cancers may undergo molecular testing when clinical management requires understanding variant function.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Lung cancers commonly have DNA alterations where transcriptome testing can clarify functional consequences for treatment decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88305`	Level IV surgical pathology, gross and microscopic examination	Used for initial anatomic pathology evaluation and selection of tumor tissue blocks for molecular testing.
`81325`	BRAF (e.g., V600) mutation analysis by sequencing methods	Molecular DNA testing that may identify mutations for which the transcriptome test evaluates functional impact.
`81445`	Oncology (solid organ) multigene panel, sequencing of tumor DNA	Comprehensive tumor DNA panels often precede transcriptome testing to identify variants of interest that require functional assessment.
`86413`	Tumor marker immunoassay (e.g., CEA)	Ancillary tumor marker testing performed in oncology workup; not a substitute but commonly ordered in the same care episode.
`G0452`	Drug screen, qualitative; multiple classes	Often performed in pre-therapy evaluation or clinical trial screening processes in oncology care pathways.

Beta

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Summary & Overview

CPT 0298U: Praxis Somatic Transcriptome, Molecular Diagnostic

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0298UCPTproprietary laboratory analysismolecular diagnosticstranscriptomeoncology testinglaboratory

Billing Code Overview

Service type: Molecular diagnostic / proprietary transcriptome analysis

Typical site of service: Clinical diagnostic laboratory

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component provided by a physician or pathologist separate from the technical lab processing.
`TC`	Technical component	Use when billing only the technical component for laboratory processing and analysis when a separate professional interpretation is not billed.
`52`	Reduced services	Use when the laboratory test is partially reduced or not performed in full, documented and medically justified.
`53`	Discontinued procedure	Use when specimen processing is started but discontinued due to unforeseen complications that prevent completion.
`62`	Two surgeons	Use when two surgeons with distinct specialties both perform necessary operative work to obtain paired tissue specimens for testing.
`78`	Unplanned return to the operating room	Use when an unplanned reoperation is required to obtain an adequate specimen for testing.
`80`	Assistant surgeon	Use when a qualified assistant surgeon participates in specimen procurement.
`22`	Increased procedural services	Use when the laboratory or pathology service provides substantially greater work than typical reportable for this test, with documentation.
`23`	Unusual anesthesia	Use when the specimen procurement required anesthesia beyond that typically used, documented in the operative/anesthesia note.
`55`	Postoperative management only	Use when only postoperative care related to specimen procurement is being reported by the surgeon separate from the test.

Taxonomy Code	Specialty	Notes
207P00000X	Pathology	Pathologists interpret molecular test results and provide clinical correlation.
207L00000X	Clinical Laboratory	Laboratory directors and clinical laboratory specialists oversee test performance and quality.
208000000X	Medical Oncology	Oncologists order the test for treatment selection and trial eligibility.
207K00000X	Anatomic Pathology	Surgical pathologists handle tissue accessioning and specimen selection for molecular testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Metastatic liver lesion commonly biopsied/resected with tumor tissue used for paired transcriptome analysis.
`C18.9`	Malignant neoplasm of colon, unspecified	Primary colorectal cancers frequently undergo DNA and RNA testing for targeted therapy selection.
`C50.919`	Malignant neoplasm of unspecified site of right female breast	Primary breast cancers often require molecular profiling including transcriptome-level assessment for functional impact of mutations.
`C61`	Malignant neoplasm of prostate gland	Prostate cancers may undergo molecular testing when clinical management requires understanding variant function.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Lung cancers commonly have DNA alterations where transcriptome testing can clarify functional consequences for treatment decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88305`	Level IV surgical pathology, gross and microscopic examination	Used for initial anatomic pathology evaluation and selection of tumor tissue blocks for molecular testing.
`81325`	BRAF (e.g., V600) mutation analysis by sequencing methods	Molecular DNA testing that may identify mutations for which the transcriptome test evaluates functional impact.
`81445`	Oncology (solid organ) multigene panel, sequencing of tumor DNA	Comprehensive tumor DNA panels often precede transcriptome testing to identify variants of interest that require functional assessment.
`86413`	Tumor marker immunoassay (e.g., CEA)	Ancillary tumor marker testing performed in oncology workup; not a substitute but commonly ordered in the same care episode.
`G0452`	Drug screen, qualitative; multiple classes	Often performed in pre-therapy evaluation or clinical trial screening processes in oncology care pathways.