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    v1.0.30
    OpenPayerBilling CodesProprietary Laboratory AnalysesCPT cpt-0498u-optiseq-colorectal-cancer-ngs-methylation-panel
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    CPT 0498U: OptiSeq Colorectal Cancer NGS Panel

    CPT code 0498U is a Proprietary Laboratory Analyses (PLA) code for the OptiSeq™ Colorectal Cancer NGS Panel from DiaCarta Inc., a next-generation sequencing (NGS) test that analyzes mutations in 43 genes and methylation patterns in 45 genes from blood and FFPE tissue to generate a detailed report with interpretation of genetic variants and methylation patterns; service type: NGS-based tumor and circulating biomarker analysis; typical site of service: clinical laboratory or hospital/ancillary pathology laboratory processing blood and formalin-fixed paraffin-embedded (FFPE) tissue specimens.

    For related coverage guidance, see recent payer policy updates: Prenatal (Fetal) Diagnostic Testing, Oral Cancer Screening and Testing, RTM Testing for Alpha-1 Antitrypsin Deficiency.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 62-year-old individual with a history of colorectal adenocarcinoma who presents for molecular profiling to guide targeted therapy and prognosis. The oncologist orders the OptiSeq™ Colorectal Cancer NGS Panel (0498U) after reviewing prior pathology showing invasive colorectal carcinoma on formalin-fixed paraffin-embedded (FFPE) tumor tissue. Peripheral blood is also collected for circulating tumor DNA (ctDNA) analysis when tumor tissue is limited or to assess minimal residual disease. The laboratory receives the FFPE tissue block or unstained slides and/or a plasma specimen, performs DNA extraction, next-generation sequencing (NGS) targeting 43 genes for somatic mutations and assays methylation patterns across 45 genes, and generates a comprehensive report with variant interpretation, allele frequencies, and methylation results. The clinical workflow includes specimen collection, chain-of-custody documentation, molecular testing under CLIA-certified procedures, analytic validation, pathologist or molecular geneticist review of reportable variants, and electronic delivery of results to the ordering oncologist. Typical clinical uses include selection of targeted therapies, enrollment decisions for clinical trials, prognostic assessment, and monitoring for recurrence using ctDNA when applicable.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    81479Unlisted molecular pathology procedureUsed when a specific proprietary PLA code is not available; for 0498U the PLA code is reported instead of 81479.
    88184Interpretation of molecular cytogenetic or molecular pathology test results (may be used for separate professional component reporting in some payor policies)May be reported by the pathologist or molecular geneticist when separate interpretive services are billed; check payer rules for bundling with 0498U.
    36415Collection of venous blood by venipunctureUsed when a peripheral blood specimen is collected for ctDNA analysis accompanying the 0498U panel.
    88305Level III surgical pathology, gross and microscopic examinationUsed when pathologist performs initial histopathology assessment of FFPE tissue prior to molecular testing; typically billed separately from the molecular test.
    G9999Placeholder for payer-specific molecular billing instructionsSome payors use local or HCPCS-level guidance for billing proprietary tests; inclusion here represents administrative steps adjacent to 0498U.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    99Modifier 99 is a placeholder modifier used when more modifiers apply to a single procedure than the claim form or electronic field allows. The AMA classifies it under Provider Services and Ambulatory…- Use CPT modifier -99 when more modifiers apply to a single procedure line than the claim form or payer field allows (CMS/Noridian: when more than four modifiers are needed); append modifier 99 on…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RG0100X
    207RH0000X
    363L00000X
    207K00000X
    291900000X
    163WP0218X
    344600000X
    364SL0600X

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    Prenatal (Fetal) Diagnostic TestingBlue Cross Blue Shield - Rhode Island2027-01-01
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Polygenic Risk ScoreBlue Cross Blue Shield - Rhode Island2026-12-01
    Gene Expression Profiling for Cutaneous MelanomaBlue Cross Blue Shield - Rhode Island2026-12-01
    Genetic Testing for Diagnosis and Management of Mental Health ConditionsBlue Cross Blue Shield - Rhode Island2026-11-01
    Molecular Testing in the Management of Pulmonary NodulesBlue Cross Blue Shield - Rhode Island2026-11-01
    Genetic Testing for Hereditary Cancer (for North Carolina Only)Colorado Rocky Mountain Health Plans2026-10-01
    Expanded Molecular Testing of Cancers to Select Targeted TherapiesBlue Cross Blue Shield - North Dakota2026-10-01

    Related Codes

    CPT-0001U-PRECISETYPE-HEA-MULTIPLEX-RBC-ANTIGEN-GENOTYPING

    CPT 0001U: PreciseType HEA Erythrocyte Antigen Genotyping

    CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

    CPT 0002U: PolypDX™ Urine Metabolomic Risk Assay

    CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

    CPT 0003U: Overa (MIA2G) Ovarian Cancer Risk Assay

    CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

    CPT 0005U: ExosomeDx Prostate (IntelliScore) urine gene expression test

    CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

    CPT 0007U: ToxProtect Urine Drug Screen With DNA Authentication

    CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

    CPT 0008U: H. pylori Antibiotic Resistance Gene Panel

    CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

    CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

    CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

    CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

    CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

    CPT 0011U: Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

    CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

    CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcripts

    Showing 1–10 of 536

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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