Summary & Overview
CPT 0490U: CellSearch Circulating Melanoma Cell (CMC) Test
CPT code 0490U designates the CellSearch® Circulating Melanoma Cell (CMC) Test, a proprietary laboratory assay that isolates and characterizes circulating tumor cells (CTCs) using specific protein biomarkers. As a PLA code, 0490U applies only to the Menarini Silicon Biosystems Inc. test and signals payers and providers that the procedure is a single-manufacturer, high-complexity laboratory service. Nationally, use of PLA codes matters for billing clarity, coverage decisions, and tracking uptake of novel diagnostics that may influence melanoma management and clinical research.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report outlines how payers approach coverage for proprietary CTC assays and identifies benchmarks for coding, claims processing, and clinical documentation expectations.
Readers will learn the clinical context and service profile of the test, the typical site of service, common billing modifiers associated with laboratory testing, and where to find additional coding and coverage information. The summary clarifies that 0490U is specific to the CellSearch® CMC Test and provides a concise reference for stakeholders handling coding, reimbursement inquiries, and administrative workflows for proprietary melanoma CTC assays.
Billing Code Overview
CPT code 0490U is a Proprietary Laboratory Analyses (PLA) code for the CellSearch® Circulating Melanoma Cell (CMC) Test from Menarini Silicon Biosystems Inc. The test uses circulating tumor cell (CTC) selection and analysis to characterize melanoma cells in a patient’s blood sample by identifying specific protein biomarkers.
Service type: Laboratory — proprietary circulating tumor cell analysis.
Typical site of service: Clinical laboratory or reference diagnostic laboratory; specimen collected in an outpatient or hospital phlebotomy setting and sent to the performing laboratory.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a history of cutaneous melanoma being monitored for disease burden or suspected recurrence. The oncology clinic orders the CellSearch® Circulating Melanoma Cell (CMC) Test (0490U) when there is clinical concern for metastatic spread, progressive disease despite therapy, or when baseline circulating tumor cell (CTC) characterization is desired to inform prognosis or clinical trials. Blood is drawn (per manufacturer instructions) during an outpatient oncology visit, infusion visit, or phlebotomy visit. The sample is sent to Menarini Silicon Biosystems Inc. or its designated laboratory for CTC selection and protein biomarker analysis. Results are returned to the ordering medical oncologist or dermatologist to support treatment planning, response assessment, or enrollment decisions in clinical research. Typical sites of service include hospital outpatient laboratories, independent reference laboratories, and ambulatory oncology clinic phlebotomy services. Common patient encounters include follow-up visits after systemic therapy, staging workups when new symptoms or imaging findings suggest metastasis, or pre-treatment baseline assessments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no modifier applies to the service |