CPT 0413U: Optical Genome Mapping for Hematolymphoid Neoplasia

CPT code 0413U designates a Proprietary Laboratory Analyses (PLA) assay — the DH Optical Genome Mapping/Digital Karyotyping Assay from The Clinical Genomics and Advanced Technology (CGAT) Laboratory at Dartmouth Health and Bionano Genomics. The test uses optical genome mapping to identify aneuploidy, copy number variations, and complex structural DNA rearrangements implicated in hematolymphoid neoplasia, providing high-resolution genomic profiling for blood and bone‑marrow cancers. As a PLA code, 0413U represents a single manufacturer's or laboratory’s unique test and is important for coding precision, prior authorization, and laboratory billing.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-level overview of the code’s clinical purpose and service context, summaries of payer coverage considerations, and explanations of where the test is typically performed. The publication highlights benchmarks and policy-relevant topics such as coding specificity for proprietary assays, site-of-service implications for laboratory-based genomic testing, and the role of advanced genomic assays in hematology-oncology diagnostic workflows.

Data not available in the input for associated taxonomies, specific ICD-10 mappings, and related billing codes.

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Billing Code Overview

CPT code 0413U is a Proprietary Laboratory Analyses (PLA) code that applies to a single, specific laboratory test: the DH Optical Genome Mapping/Digital Karyotyping Assay developed by The Clinical Genomics and Advanced Technology (CGAT) Laboratory at Dartmouth Health and Bionano Genomics. The assay uses optical genome mapping (OGM) to detect aneuploidy, copy number variations (CNVs), and complex structural DNA rearrangements associated with hematolymphoid neoplasia (blood and bone–marrow cancers).

Service type: Diagnostic genetic testing using optical genome mapping.

Typical site of service: Clinical molecular/genomics laboratory with results used for inpatient or outpatient hematology/oncology care.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

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CPT 0413U: Optical Genome Mapping for Hematolymphoid Neoplasia

Data not available in the input for associated taxonomies, specific ICD-10 mappings, and related billing codes.

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Get alerted when payer policies referencing 0413U are released or updated.

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Billing Code Overview

Service type: Diagnostic genetic testing using optical genome mapping.

Typical site of service: Clinical molecular/genomics laboratory with results used for inpatient or outpatient hematology/oncology care.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with newly diagnosed acute myeloid leukemia (AML) presents after abnormal peripheral blood counts and a bone marrow biopsy showing blasts. Standard cytogenetics and fluorescence in situ hybridization (FISH) were inconclusive for complex structural rearrangements. The treating hematologist orders the DH Optical Genome Mapping/Digital Karyotyping Assay (0413U) to detect aneuploidy, copy number variations (CNVs), and cryptic structural variants that may influence prognosis and targeted therapy selection. Peripheral blood or bone marrow aspirate is sent to the Clinical Genomics and Advanced Technology (CGAT) Laboratory at Dartmouth Health or the Bionano Genomics laboratory. The lab receives the specimen, performs optical genome mapping (OGM), analyzes structural variant calls and CNV profiles, and generates a report integrated into the patient’s electronic health record for the oncology team to review. Typical site of service is an inpatient hematology/oncology unit, outpatient oncology clinic, or an affiliated molecular diagnostics reference laboratory. Service type: proprietary laboratory analysis/molecular pathology diagnostic testing for hematolymphoid neoplasia.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C92.0`	Acute myeloblastic leukemia not having achieved remission	OGM identifies structural variants and CNVs that inform prognosis and targeted therapy in AML
`C91.0`	Acute lymphoblastic leukemia, B-cell	Optical genome mapping can detect structural abnormalities relevant to lymphoid leukemias
`C83.9`	Non-follicular lymphoma, unspecified	Structural rearrangements and CNVs in lymphomas may be characterized by OGM in difficult diagnostic cases
`D47.1`	Chronic myeloproliferative disease	OGM can detect complex genomic rearrangements in myeloproliferative neoplasms affecting management
`C90.00`	Multiple myeloma not having achieved remission	OGM may reveal copy number changes and translocations relevant for prognostication in plasma cell neoplasms

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80047`	Basic metabolic panel	Pre-analytic and baseline laboratory panel often obtained concurrently in oncology workup
`88384`	Immunohistochemistry, per antibody stain	Performed on bone marrow or tissue biopsies when morphology and IGM results correlate with OGM findings
`81275`	BRCA1 and BRCA2 full sequence analysis (example of molecular sequencing)	Represents adjunct molecular testing; different methodology but conceptually related as a targeted genetic assay
`81599`	Unlisted molecular pathology procedure	Rarely used for novel or unlisted tests; `0413U` is the PLA code that supersedes using unlisted code for this specific assay
`88112`	Cytogenetic analysis, bone marrow; full chromosome analysis (karyotype)	Traditional cytogenetics often performed before or alongside OGM to detect large structural chromosomal abnormalities

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
207RP1001X	Pulmonary Disease Physician	An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
261QP0905X	State or Local Public Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
261QE0800X	Endoscopy Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
133VN1501X	Sports Dietetics Nutrition Registered Dietitian	An individual who is a Board Certified Specialist in Sports Dietetics and applies evidence-based nutrition knowledge in exercise and sports. RDNs spec…
3104A0630X	Assisted Living Facility (Behavioral Disturbances)	A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral resp…

CPT 0001U: PreciseType HEA Multiplex Erythrocyte Antigen Assay

CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

CPT 0002U: Urine Metabolomic Polyp Risk Assay (PolypDX™)

CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

CPT 0003U: Overa™ (OVA1 Next Generation) Ovarian Cancer Risk Assay

CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

CPT 0005U: ExosomeDx Prostate (IntelliScore) Urine Gene Expression Risk Test

CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

CPT 0007U: ToxProtect Urine Drug Screen with DNA Authentication

CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

CPT 0008U: H. pylori Antibiotic Resistance Panel, Gene Sequence Analysis

CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

CPT 0011U: Cordant CORE™ Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcript Testing

Showing 1–10 of 536

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C92.0`	Acute myeloblastic leukemia not having achieved remission	OGM identifies structural variants and CNVs that inform prognosis and targeted therapy in AML
`C91.0`	Acute lymphoblastic leukemia, B-cell	Optical genome mapping can detect structural abnormalities relevant to lymphoid leukemias
`C83.9`	Non-follicular lymphoma, unspecified	Structural rearrangements and CNVs in lymphomas may be characterized by OGM in difficult diagnostic cases
`D47.1`	Chronic myeloproliferative disease	OGM can detect complex genomic rearrangements in myeloproliferative neoplasms affecting management
`C90.00`	Multiple myeloma not having achieved remission	OGM may reveal copy number changes and translocations relevant for prognostication in plasma cell neoplasms

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80047`	Basic metabolic panel	Pre-analytic and baseline laboratory panel often obtained concurrently in oncology workup
`88384`	Immunohistochemistry, per antibody stain	Performed on bone marrow or tissue biopsies when morphology and IGM results correlate with OGM findings
`81275`	BRCA1 and BRCA2 full sequence analysis (example of molecular sequencing)	Represents adjunct molecular testing; different methodology but conceptually related as a targeted genetic assay
`81599`	Unlisted molecular pathology procedure	Rarely used for novel or unlisted tests; `0413U` is the PLA code that supersedes using unlisted code for this specific assay
`88112`	Cytogenetic analysis, bone marrow; full chromosome analysis (karyotype)	Traditional cytogenetics often performed before or alongside OGM to detect large structural chromosomal abnormalities

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
207RP1001X	Pulmonary Disease Physician	An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
261QP0905X	State or Local Public Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
261QE0800X	Endoscopy Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
133VN1501X	Sports Dietetics Nutrition Registered Dietitian	An individual who is a Board Certified Specialist in Sports Dietetics and applies evidence-based nutrition knowledge in exercise and sports. RDNs spec…
3104A0630X	Assisted Living Facility (Behavioral Disturbances)	A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral resp…

CPT 0001U: PreciseType HEA Multiplex Erythrocyte Antigen Assay

CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

CPT 0002U: Urine Metabolomic Polyp Risk Assay (PolypDX™)

CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

CPT 0003U: Overa™ (OVA1 Next Generation) Ovarian Cancer Risk Assay

CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

CPT 0005U: ExosomeDx Prostate (IntelliScore) Urine Gene Expression Risk Test

CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

CPT 0007U: ToxProtect Urine Drug Screen with DNA Authentication

CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

CPT 0008U: H. pylori Antibiotic Resistance Panel, Gene Sequence Analysis

CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

CPT 0011U: Cordant CORE™ Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcript Testing

Showing 1–10 of 536

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 0413U: Optical Genome Mapping for Hematolymphoid Neoplasia

Sign up for cpt 0413U policy alerts

Billing Code Overview

OpenPayer

CPT 0413U: Optical Genome Mapping for Hematolymphoid Neoplasia

Sign up for cpt 0413U policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

CPT 0413U: Optical Genome Mapping for Hematolymphoid Neoplasia

Sign up for cpt 0413U policy alerts

Billing Code Overview

CPT 0413U: Optical Genome Mapping for Hematolymphoid Neoplasia

Sign up for cpt 0413U policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 0413U represent and when should it be reported?

Where is the DH Optical Genome Mapping/Digital Karyotyping Assay usually performed?

Which billing modifiers apply to CPT 0413U and what do they indicate?

In what clinical situations is 0413U typically ordered and what results does it provide?

Which payers are noted as covering 0413U and does the page provide reimbursement rates or coverage criteria?

References

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 0413U represent and when should it be reported?

Where is the DH Optical Genome Mapping/Digital Karyotyping Assay usually performed?

Which billing modifiers apply to CPT 0413U and what do they indicate?

In what clinical situations is 0413U typically ordered and what results does it provide?

Which payers are noted as covering 0413U and does the page provide reimbursement rates or coverage criteria?

References