Summary & Overview
CPT 0487U: ctDNA Next-Generation Sequencing (Northstar Select™)
CPT code 0487U designates a proprietary next-generation sequencing laboratory test, Northstar Select™ from BillionToOne Laboratory, for analysis of cell-free circulating tumor DNA (ctDNA) from a blood sample. As a PLA code, 0487U is reserved for a single manufacturer's assay and signals unique pricing, coverage, and billing considerations compared with non-proprietary molecular tests. Nationally, this code matters because ctDNA assays are increasingly used for noninvasive tumor profiling, therapy selection, and detection of microsatellite instability across oncology practices.
Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the test’s clinical purpose and service context, common modifier usage, and what to expect in payer coverage discussions. The publication synthesizes benchmark topics such as coding specificity for PLA tests, payer policy themes relevant to tumor sequencing from blood, and implications for billing workflows and claim adjudication.
This report is intended for billing managers, laboratory administrators, and policy analysts who need a clear, national-level briefing on CPT code 0487U, including clinical context, payer landscape, and operational considerations for integrating a proprietary ctDNA NGS assay into practice workflows.
Billing Code Overview
CPT code 0487U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to the Northstar Select™ test from BillionToOne Laboratory, BillionToOne Inc. The test uses next-generation sequencing of a blood sample to analyze cell-free circulating tumor DNA (ctDNA) from solid tumors. It detects sequence variants, gene copy number changes, gene rearrangements, and microsatellite instability.
Service Type: Laboratory — next-generation sequencing (liquid biopsy) for circulating tumor DNA analysis
Typical Site of Service: Clinical laboratory or outpatient blood draw collection site
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a known or suspected solid tumor undergoing precision oncology management. The clinician orders the Northstar Select™ cell‑free tumor NGS assay (0487U) when tissue biopsy is unobtainable, insufficient, or when a noninvasive serial genomic assessment is required to detect tumor-derived sequence variants, copy number changes, gene rearrangements, and microsatellite instability from circulating cell‑free DNA. A peripheral blood draw (plasma) is collected in a validated tube and sent to BillionToOne Laboratory, BillionToOne Inc. The laboratory performs next‑generation sequencing and reports clinically actionable somatic variants and biomarkers that inform targeted therapy selection, clinical trial eligibility, or monitoring of molecular residual disease. Typical workflow steps: clinician documents indication and orders test; phlebotomy collects and ships specimen under chain‑of‑custody; laboratory performs NGS and bioinformatics analysis; results routed to ordering oncologist for interpretation and treatment planning; results may be placed into the electronic medical record and discussed at tumor board or care planning visits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing separates the professional interpretation/reporting component from the technical laboratory processing, if applicable under payer rules. |
| | Reduced services | When the test is partially completed or limited in scope relative to the full assay (use per payer policy).