Summary & Overview
CPT 0430U: Malabsorption Evaluation Panel, Fecal Biomarker Test
Headline: New PLA Code CPT 0430U Designates Mayo Clinic’s Malabsorption Evaluation Panel
Lead: CPT code 0430U identifies a proprietary laboratory assay — the Malabsorption Evaluation Panel from Mayo Clinic Laboratories — that measures four fecal biomarkers to aid diagnosis and differentiation of gastrointestinal malabsorption. The unique PLA designation limits use to the single performing laboratory and clarifies billing and reporting for payers and providers.
CPT code 0430U matters nationally because it standardizes reporting for a specialized diagnostic test tied to one laboratory and supports consistent claims processing across commercial and public payers. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical purpose, the service context and typical site of service, and what to look for in payer coverage and claims workflows. The content summarizes available benchmarking and policy considerations relevant to proprietary lab tests and outlines clinical context for use of fecal biomarker panels in malabsorption evaluation.
This publication provides concise reference material for billing staff, laboratory administrators, and policy analysts seeking clarity on PLA billing, payer engagement, and operational considerations for implementing CPT code 0430U. Data not available in the input: payer-specific coverage rules, reimbursement rates, associated taxonomies, and ICD-10 diagnoses.
Billing Code Overview
CPT code 0430U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to a single, manufacturer- or lab-specific test: the Malabsorption Evaluation Panel from Mayo Clinic/Mayo Clinic Laboratories. The test evaluates a fecal specimen for levels of four specific biomarkers that assist in diagnosing and differentiating malabsorption disorders of the gastrointestinal tract.
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Service type: Laboratory diagnostic test — Proprietary Laboratory Analysis performed on a fecal specimen
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Typical site of service: Clinical laboratory or reference laboratory setting; specimens collected in outpatient clinics or inpatient settings and sent to the performing laboratory
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to a gastroenterology clinic with chronic diarrhea, weight loss, and steatorrhea despite empiric dietary changes. The gastroenterologist orders the Malabsorption Evaluation Panel from Mayo Clinic Laboratories to evaluate fecal biomarkers that help distinguish pancreatic exocrine insufficiency, bile acid malabsorption, mucosal malabsorption, and inflammatory causes. A stool specimen is collected either in the clinic or by the patient at home per laboratory instructions and shipped to the reference lab. Results are reviewed by the ordering clinician; abnormal patterns guide further testing such as pancreatic function testing, endoscopic evaluation with biopsies, diagnostic imaging, or therapeutic trials (e.g., pancreatic enzyme replacement or bile acid sequestrants). Typical sites of service include outpatient gastroenterology clinics, hospital outpatient laboratories, or reference laboratory facilities processing mailed-in specimens.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier reported | Use as default when no special modifier applies |
26 | Professional component | Use when billing only the professional interpretation portion if applicable to lab consultative interpretation |