Summary & Overview
CPT 0425U: RCIGM Rapid Whole Genome Sequencing, Comparator Genome
CPT code 0425U designates a proprietary laboratory test — RCIGM Rapid Whole Genome Sequencing, Comparator Genome — performed by Rady Children’s Institute for Genomic Medicine. The PLA code covers a rapid whole genome sequencing analysis that uses a sample from a parent or sibling to identify inherited genetic variants in a symptomatic child. Nationally, this code matters because rapid genomic results can affect diagnostic trajectories and acute clinical decision-making for pediatric patients with suspected genetic disorders.
Key payers examined in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how the code is defined, typical clinical use and sites of service, and which payers are included in benchmarking. The publication outlines where to find coverage and coding guidance, common modifiers that may appear on claims, and the clinical context for ordering rapid trio or family-based whole genome sequencing.
This resource provides actionable reference material for billing and coding professionals, laboratory administrators, and clinicians seeking clarity on the code’s intended use, payer coverage coverage landscape, and the laboratory service model associated with rapid comparator genome testing. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 0425U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to a single, manufacturer- or laboratory-specific test. Report 0425U only for RCIGM Rapid Whole Genome Sequencing, Comparator Genome, from Rady Children’s Institute for Genomic Medicine. The test uses a sample such as blood from a parent or sibling of a symptomatic child and involves whole genome sequence analysis to rapidly identify genetic variants that the symptomatic patient may have inherited.
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Service type: Rapid whole genome sequencing panel using comparator family member samples
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Typical site of service: Clinical laboratory or specialized molecular diagnostics laboratory; testing is performed by the reporting laboratory (reference or specialty lab)
Clinical & Coding Specifications
Clinical Context
A neonate or infant in the neonatal intensive care unit (NICU) presents with multiple congenital anomalies, refractory seizures, hypotonia, or rapidly progressive multi-organ dysfunction. Prior to testing, the clinical team obtains informed consent and collects blood samples from the symptomatic child and a parent or sibling as a comparator specimen. The clinical workflow includes: initial urgent genetics consult, sample collection and couriering to Rady Children’s Institute for Genomic Medicine, performance of RCIGM Rapid Whole Genome Sequencing with Comparator Genome (0425U), bioinformatic analysis to identify pathogenic or likely pathogenic inherited variants and interpretation by laboratory geneticists, expedited return of results to the treating team, and integration of findings into clinical management (diagnosis confirmation, targeted therapies, prognostic counseling, or cascade testing of family members). Typical sites of service are the hospital inpatient setting (NICU or pediatric intensive care unit) and specialized pediatric genetics laboratories performing the proprietary test. Common clinical scenarios include critically ill newborns with suspected genetic disorders, infants with unexplained metabolic crises, or pediatric patients with a strong family history of a genetic condition where parental comparator sequencing clarifies inheritance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no special circumstances modify the service; report alone. |