Summary & Overview
CPT 0426U: RCIGM Ultra‑Rapid Whole Genome Sequencing
CPT code 0426U represents a proprietary lab test: RCIGM Ultra–Rapid Whole Genome Sequencing from Rady Children’s Institute for Genomic Medicine. The PLA code designates a single-manufacturer/single-test service that delivers rapid whole genome sequencing and analysis from a sample such as blood to assist in diagnosing or ruling out genetic conditions in newborns and symptomatic pediatric patients. Nationally, PLA codes like 0426U are important because they identify uniquely branded genomic diagnostics with specific clinical and payer pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code denotes, the clinical context for use in neonatal and pediatric care, expected sites of service, and common billing modifiers when applicable. The publication summarizes available benchmarks and payer coverage considerations, highlights relevant policy and coding updates that affect proprietary genomic testing, and provides a clinical context for why rapid whole genome sequencing can be used in acute pediatric diagnostic workflows.
This summary is written for a national audience and focuses on code meaning, clinical setting, and payer coverage landscape. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 0426U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to a single laboratory test: RCIGM Ultra–Rapid Whole Genome Sequencing from Rady Children’s Institute for Genomic Medicine. The test uses a patient sample such as blood to perform whole genome sequencing and analysis to rapidly identify genetic variants that can help diagnose or rule out genetic diseases in newborns or symptomatic pediatric patients.
Service Type: Ultra‑rapid whole genome sequencing and analysis
Typical Site of Service: Clinical molecular diagnostics laboratory or hospital-based laboratory with neonatal or pediatric inpatient and outpatient services
Clinical & Coding Specifications
Clinical Context
A neonate in the neonatal intensive care unit (NICU) or an infant/young child admitted to a pediatric unit presents with multiple congenital anomalies, unexplained metabolic decompensation, refractory seizures, hypotonia, or other rapidly progressive, life‑threatening features suggesting an underlying genetic disorder. Initial stabilization and standard diagnostic labs/imaging are performed. Because time is critical for targeted therapy, RCIGM Ultra–Rapid Whole Genome Sequencing (0426U) is ordered by the treating neonatologist or pediatric geneticist. Blood (typically EDTA whole blood) is collected, sent to Rady Children’s Institute for Genomic Medicine, and processed under the laboratory’s rapid pipeline. Results, often returned within 24–72 hours, are reviewed by the clinical team and the laboratory’s geneticists to identify pathogenic or likely pathogenic variants, guiding precision management (targeted therapies, medication changes, prognosis, surgical planning, or palliative care discussions). The workflow includes pre‑test consent, specimen collection, courier to the performing lab, laboratory analysis and interpretation, multidisciplinary review, and documentation of results and clinical actions in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Modifier not otherwise specified (report as per payer rules) | Use when no other applicable modifier from the list better describes the service; follow payer guidance for proprietary lab tests. |