Summary & Overview

CPT 0372U: Qlear UTI – Reflex ABR, Urine Nucleic Acid Antibiotic Resistance Test

CPT code 0372U designates a Proprietary Laboratory Analyses (PLA) test — Qlear UTI – Reflex ABR from Lifescan Labs of Illinois, Thermo Fisher Scientific — that detects pathogen nucleic acids from urine to evaluate antibiotic resistance. As a PLA code, 0372U applies only to this single, manufacturer- or lab-specific molecular diagnostic assay, which has implications for coding specificity, coverage pathways, and lab formularies nationwide.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary outlines how PLA coding affects national reimbursement processes, prior authorization considerations, and clinical integration for outpatient and laboratory settings.

Readers will learn: the clinical purpose of the test and typical sites of service; how PLA designation influences billing and payer engagement; benchmark considerations for coverage and reimbursement; and policy-relevant updates that affect access to proprietary molecular diagnostics. Data not available in the input is noted where payer-specific coverage policies, associated taxonomies, ICD-10 diagnoses, and related codes would otherwise be detailed.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0372UCPTProprietary Laboratory Analysesmolecular diagnosticsantibiotic resistanceurine testingclinical laboratorylaboratory billingPLA code

Billing Code Overview

CPT code 0372U is a Proprietary Laboratory Analyses (PLA) code specific to a single laboratory test. Report 0372U only for Qlear UTI – Reflex ABR performed by Lifescan Labs of Illinois, Thermo Fisher Scientific. The test evaluates pathogen nucleic acids identified from a urine specimen to assess antibiotic resistance (ABR).

Service Type: Laboratory diagnostic test — molecular nucleic acid analysis for antibiotic resistance

Typical Site of Service: Clinical laboratory or outpatient specimen collection site (urine specimen)

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to a primary care clinic or urgent care with symptoms of a urinary tract infection (dysuria, urinary frequency, suprapubic pain, or fever) or a patient with recurrent or complicated UTI where prior empiric therapy failed. A urine specimen is collected and sent to a reference laboratory for the Qlear UTI – Reflex ABR test (0372U) performed by Lifescan Labs of Illinois, Thermo Fisher Scientific. The testing workflow: the specimen is received and screened by the nucleic-acid–based assay to identify uropathogens; when pathogen nucleic acids are detected, the reflex antibiotic resistance (ABR) analysis is performed to identify resistance markers. Results are reported to the ordering clinician to inform targeted antimicrobial therapy and stewardship. Typical sites of service include outpatient clinics, urgent care centers, emergency departments, and independent clinical laboratories processing referred specimens.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the professional interpretation component of the test is billed separately by the physician/lab providing interpretation.
`TC`	Technical component	Use when only the technical component (laboratory processing and analysis) is billed by the performing laboratory.
`QX`	Rendering provider is CLIA-waived? (modifier for laboratory exchange)	Use when specimen handling or billing requires identification of the performing/receiving entity under contractual arrangements (applies per payer rules).
`QY`	Laboratory test performed at an independent laboratory under a contractual arrangement	Use when the test is performed under a contractual laboratory service arrangement.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when an advanced practice clinician provides the professional component under applicable state law and payer rules.
`22`	Increased procedural services	Use when substantially greater work is required for interpretation or reporting beyond typical for the test (rare for standardized PLAs).
`52`	Reduced services	Use when the test is partially reduced or not fully performed.
`53`	Discontinued procedure	Use if specimen collection or assay was started but discontinued before completion.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure	Generally not applicable; include only if clinically relevant in complex inpatient workflows.
`80`	Assistant surgeon	Generally not applicable; include only if a surgical assistant bills an associated service.

Taxonomy Code	Specialty	Notes
207Q00000X	Microbiology Laboratory	Clinical laboratory specialists and directors responsible for molecular testing workflows.
207L00000X	Pathology	Anatomic and clinical pathologists overseeing laboratory test validation and interpretation.
363L00000X	Laboratory Director	Laboratory medicine directors who manage PLAs and reporting compliance.
207K00000X	Infectious Disease	Infectious disease specialists who may order and interpret ABR results for complex cases.
207RC0000X	Family Medicine	Primary care clinicians who commonly order UTI molecular testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87086`	Culture, bacterial isolate, screening for antibiotic resistance	Performed when conventional culture-based susceptibility testing is performed in parallel or as follow-up to molecular ABR findings.
`87506`	Infectious agent detection by nucleic acid (e.g., urine), amplified probe technique, multiple organisms	Performed for molecular detection of urinary pathogens; may be ordered alongside or prior to reflex ABR testing.
`81001`	Urinalysis, automated, with microscopy	Initial point-of-care or laboratory urinalysis commonly performed at presentation prior to ordering molecular pathogen testing.
`87070`	Culture, bacterial; urine, colony count	Used when quantitative urine culture is indicated to correlate molecular findings with organism load.
`88347`	Surgical pathology, gross and microscopic examination (if applicable)	Rarely related; included for completeness when tissue samples require pathologic evaluation in complicated infections.

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Summary & Overview

CPT 0372U: Qlear UTI – Reflex ABR, Urine Nucleic Acid Antibiotic Resistance Test

Billing Code Overview

Service Type: Laboratory diagnostic test — molecular nucleic acid analysis for antibiotic resistance

Typical Site of Service: Clinical laboratory or outpatient specimen collection site (urine specimen)

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the professional interpretation component of the test is billed separately by the physician/lab providing interpretation.
`TC`	Technical component	Use when only the technical component (laboratory processing and analysis) is billed by the performing laboratory.
`QX`	Rendering provider is CLIA-waived? (modifier for laboratory exchange)	Use when specimen handling or billing requires identification of the performing/receiving entity under contractual arrangements (applies per payer rules).
`QY`	Laboratory test performed at an independent laboratory under a contractual arrangement	Use when the test is performed under a contractual laboratory service arrangement.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when an advanced practice clinician provides the professional component under applicable state law and payer rules.
`22`	Increased procedural services	Use when substantially greater work is required for interpretation or reporting beyond typical for the test (rare for standardized PLAs).
`52`	Reduced services	Use when the test is partially reduced or not fully performed.
`53`	Discontinued procedure	Use if specimen collection or assay was started but discontinued before completion.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure	Generally not applicable; include only if clinically relevant in complex inpatient workflows.
`80`	Assistant surgeon	Generally not applicable; include only if a surgical assistant bills an associated service.

Taxonomy Code	Specialty	Notes
207Q00000X	Microbiology Laboratory	Clinical laboratory specialists and directors responsible for molecular testing workflows.
207L00000X	Pathology	Anatomic and clinical pathologists overseeing laboratory test validation and interpretation.
363L00000X	Laboratory Director	Laboratory medicine directors who manage PLAs and reporting compliance.
207K00000X	Infectious Disease	Infectious disease specialists who may order and interpret ABR results for complex cases.
207RC0000X	Family Medicine	Primary care clinicians who commonly order UTI molecular testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87086`	Culture, bacterial isolate, screening for antibiotic resistance	Performed when conventional culture-based susceptibility testing is performed in parallel or as follow-up to molecular ABR findings.
`87506`	Infectious agent detection by nucleic acid (e.g., urine), amplified probe technique, multiple organisms	Performed for molecular detection of urinary pathogens; may be ordered alongside or prior to reflex ABR testing.
`81001`	Urinalysis, automated, with microscopy	Initial point-of-care or laboratory urinalysis commonly performed at presentation prior to ordering molecular pathogen testing.
`87070`	Culture, bacterial; urine, colony count	Used when quantitative urine culture is indicated to correlate molecular findings with organism load.
`88347`	Surgical pathology, gross and microscopic examination (if applicable)	Rarely related; included for completeness when tissue samples require pathologic evaluation in complicated infections.