Summary & Overview

CPT 0467U: UroAmp MRD NGS Urine Test for Bladder Cancer

CPT code 0467U identifies UroAmp MRD, a proprietary next-generation sequencing (NGS) urine test from Convergent Genomics Inc. that evaluates 60 genes and genome-wide aneuploidy to determine minimal residual disease (MRD) status and quantify disease burden for bladder cancer. As a PLA code, 0467U is specific to a single manufacturer’s test, which frames coverage and coding discussions around proprietary laboratory technology and analytic validity. Nationally, PLA codes like 0467U matter for payers and providers because they influence how novel diagnostics are evaluated for clinical utility, coding clarity, and reimbursement pathways.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the test’s clinical purpose and service setting, an outline of payer coverage considerations, and a summary of typical billing elements and modifiers associated with lab-based molecular diagnostics. The publication presents benchmarks and policy-relevant context for PLA-coded tests, covering issues such as single-source coding implications, claims processing considerations, and the role of quantitative MRD reporting in clinical workflows. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0467UCPTProprietary Laboratory AnalysesUroAmpMRDnext-generation sequencingurine-based assaybladder cancermolecular diagnostics

Billing Code Overview

CPT code 0467U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to the UroAmp MRD test from Convergent Genomics Inc. The assay uses next-generation sequencing (NGS) on a urine sample to evaluate 60 specified genes and perform genome-wide aneuploidy analysis. Results are processed through proprietary algorithms to report minimal residual disease (MRD) status as either positive or negative, and to provide a quantitative disease burden metric indicating the amount of cancer-derived signal detected.

Service type: Molecular diagnostic laboratory test (proprietary NGS-based MRD assay)

Typical site of service: Clinical laboratory or hospital outpatient laboratory, with specimen collection from a urine sample.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of high-grade non–muscle-invasive bladder cancer (NMIBC) undergoes transurethral resection of bladder tumor (TURBT) and completes intravesical therapy. During surveillance, the urologist orders the UroAmp MRD urine test (0467U) from Convergent Genomics Inc. to assess for minimal residual disease following treatment. A clean-catch urine specimen is collected in clinic and shipped to the performing laboratory. The laboratory performs next-generation sequencing (NGS) targeting 60 bladder cancer–associated genes and assesses genome-wide aneuploidy; proprietary algorithms generate a binary MRD result (positive/negative) and a quantitative disease burden metric. Results are returned to the ordering urologist to inform surveillance decisions such as intensified cystoscopic surveillance, imaging, or consideration of additional therapy. Typical site of service is an outpatient urology clinic or freestanding specimen collection center with testing performed in a certified molecular diagnostics laboratory.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the professional interpretation component separate from the laboratory technical component (rare for PLA tests).

Taxonomy Code	Specialty	Notes
208800000X	Urology	Ordering and clinical interpretation of bladder cancer surveillance testing.
207Q00000X	Pathology	Molecular pathology oversight and interpretation of complex NGS assays.
207L00000X	Clinical Laboratory	Laboratory directors and laboratory specialists who perform or oversee testing.
363A00000X	Hematology & Oncology	Medical oncologists who may use MRD results for systemic therapy decisions.

ICD-10 Code	Description	Clinical Relevance
`C67.9`	Malignant neoplasm of bladder, unspecified	Primary diagnosis for patients undergoing bladder cancer MRD testing.
`C67.2`	Malignant neoplasm of lateral wall of bladder	Specific tumor location; used in staging and surveillance planning tied to MRD testing.
`C67.4`	Malignant neoplasm of trigone of bladder	Tumors in trigone often require close surveillance; MRD can assist in detecting residual disease.
`D09.0`	Carcinoma in situ of bladder	CIS is a high-risk lesion; urine MRD testing may be used in post-treatment surveillance.
`Z85.51`	Personal history of malignant neoplasm of bladder	Used for surveillance context after prior bladder cancer; supports ordering MRD testing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88184`	Flow cytometry, each additional marker (List separately in addition to code for primary procedure)	May be performed in parallel in some centers for cellular analysis of urine specimens when cytometric evaluation is indicated.
`88342`	Immunohistochemistry or immunocytochemistry, per slide; initial single antibody stain	Performed on tissue or cytology specimens obtained during cystoscopy that complement urine-based molecular MRD results.
`88305`	Surgical pathology, gross and microscopic examination, intermediate complexity	For pathology evaluation of TURBT specimens whose results correlate with urine MRD testing.
`81002`	Urinalysis, non-automated, without microscopy	Point-of-care urinalysis collected at time of urine specimen collection; often performed in clinic prior to sending urine for molecular testing.
`88112`	Cytopathology, urine or body fluid; manual review and interpretation	Cytologic evaluation of urine may be ordered alongside `0467U` to provide complementary morphological assessment.

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