Summary & Overview
CPT 0468U: NASHnext (NIS4) Blood-Based NASH Biomarker Panel
CPT code 0468U designates a Proprietary Laboratory Analyses (PLA) test reserved for NASHnext™ (NIS4™) from Labcorp, a blood-based biomarker panel and algorithm that reports a single score reflecting nonalcoholic steatohepatitis (NASH) activity and liver fibrosis. As a PLA code, 0468U is specific to one manufacturer’s test and signals payers and providers that the procedure is a proprietary diagnostic service with unique coding. Nationally, accurate coding for novel diagnostics matters for claims processing, utilization tracking, and clarity in laboratory reporting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical purpose of the test, typical sites of service, payer coverage landscape, and how the PLA designation affects billing and reporting. The publication provides benchmarks and policy context relevant to proprietary lab tests, summarizes payer considerations for coverage and coding consistency, and outlines typical clinical applications for NASH assessment. Data not available in the input is noted where applicable, and the content focuses on national implications for coding, billing, and clinical interpretation rather than state-specific rules.
Billing Code Overview
CPT code 0468U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to the NASHnext™ (NIS4™) test from Labcorp. This serum and whole blood laboratory assay measures a panel of biomarkers and uses a proprietary algorithm to generate a single score indicating nonalcoholic steatohepatitis (NASH) activity and the extent of liver fibrosis.
Service type: Laboratory testing — Proprietary algorithmic biomarker panel for NASH risk and fibrosis staging.
Typical site of service: Clinical laboratory or outpatient phlebotomy site where blood specimens are collected and processed by the performing laboratory.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with obesity and type 2 diabetes is referred by their primary care physician to hepatology for evaluation of suspected nonalcoholic fatty liver disease (NAFLD). Laboratory evaluation and transient elastography suggest possible active nonalcoholic steatohepatitis (NASH) with fibrosis. The clinician orders the proprietary serum and whole-blood biomarker panel NASHnext™ (NIS4™) — billed as 0468U — to quantify disease activity and fibrosis risk. A phlebotomy appointment is scheduled at an outpatient laboratory or hospital outpatient draw station. A serum tube and a whole-blood tube are collected, and specimens are sent to the performing laboratory (Labcorp) for specialized biomarker analysis. Results return as a single algorithm-derived score that the hepatology team uses with imaging, labs, and clinical data to stage disease and discuss management options with the patient.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician or professional interpretation component, if applicable to lab consultative reporting. |
TC | Technical component |